New to Neuro ICU and need advice

[GGBRN]

I transferred from a neuro surgical step down unit to Cardiac/Neuro ICU. Our unit will be splitting to neuro next month, so I still get some cards pts, but not as many. Anyway, at first I felt like I was really interested in neurology and I was eager and excited to become apart of the new neuro ICU. Now, I feel overwhelmed and burnt out. Working with neuro ICU pt's is frustrating and depressing. Not many neuro patients have great outcomes, but my frustration is equally based on pt outcomes and the collaboration and attitude of the teams within my hospital.

For example, for the past 3 nights I've had a pt that neurosurgery was following but the primary team was neuro critical care. I called NCC at the beginning of my shift and asked if they were planning on another CT in the am and they said no. However I got a call at 545 (my shift ends at 645) from neurosurgery DEMANDING a STAT ct. Meanwhile this pt was hypotensive. I was trying to explain to the neuro surg resident that I'm not doing a STAT ct if the pt is unstable. In addition, the last THREE CT scans revealed a stabilized bleed. Not my call though, of course, I'm just a nurse.

Ended up giving a bolus and went to the CT. At the end of the day, who cares about my complaints, but really this is a reflection of the collaboration of the teams within my hospital. Are you serious? this is how my hospital functions... I know that there are issues at every hospital, but is this normal?

Also, the NCC team attitude is to trach and peg every single person they can. There seems to be no consideration for quality of life, but in quantity. I don't believe in placing a trach and peg in a 80 year old comatose stroke survivor, but that's just me. I have been around the team when they have conversations with the family decision makers and they explain the situation without equal emphasis on all options - their focus is on life-preserving efforts. Is this a numbers game?

Sustaining a life that will be bound to a bed and at the mercy of care takers seems like a torturous way to live, but again that's just my opinion.

I would like to hear some other RN experiences in the neuro ICU. Wondering if my experience within my hospital are unique or the norm.

[MissM.RN, BSN, RN]

GGBRN, know that you are not alone. You and I work with the same population. at my hospital you would think that neuro critical and neuro-surg had no idea each other existed. my strategy is to take myself out of it. i simply state "i would rather not be an intermediary as that risks errors, and please discuss the need for a CT with neuro critical" and walk away. i do the same when they try to make me take verbal orders.

sadly our neuro/trauma/stroke patients really do have poor outcomes. what is shocking is how little insight our house MDs have about that. no palliative consult and full code status after a stroke/seizures/trache/PEG? in my opinion, that's absurd. if the family declines palliative, fine. but how many are even offered it, or given a glimpse of the patient's soon-to-be quality of life?