Nursing - changing me for the worse

[king red]

I don't really know what I hope to accomplish by posting here, but I'll give it a shot anyway. Thanks in advance for listening.

I'm coming up on one year since I passed the Board and started off in the MICU. My coworkers and supervisors have been great and very helpful at all times. However, despite the fact that I have recently become engaged and bought a house, I have become a different person. I dread going to work to the point of becoming sick to my stomach and do nothing but whine and complain to my fiance about my job. I worked as a pharmacy tech before and if it wasn't for the (slightly) higher paycheck, I would go back in a heartbeat. The never-ending abyss of knowledge I need to acquire, the introduction of new paperwork everyday, worrying about being involved in a lawsuit and losing my livelihood, knowing that any "mistake" I might make on the job could make me a criminal, the lack of a tech or unit secretary at night, etc are things that are weighing heavily on my mind. The night shift is killing me. I've been doing nights for six years now (as a pharmacy tech before nursing). I would like to switch to days to spend more time with my fiance and other family and friends, but day shift gets paid less and the ICU is chaos during the day and I don't know if I could handle it.

I usually work the typical 12 hour shift, but I work an extra 4 hour shift every other week. My last shift was one of those short 4 hour shifts. I have been sick the last few days so I called and asked to be cancelled, but they said they needed me. I go in and get my assignment. My first patient is an obese man on a vent and multiple drips with Qhour glucose checks with a pending trip down for a CT scan. I'm also up for the next admission. CT shows up without ever calling first, so I have to rush and call the RT to set up the portable vent, etc. The unit secretary then informs me that I have a new patient coming in...great. So I head down to CT and struggle trying to get the obese patient into the machine, etc (the propofol was already maxed and he was still fighting). I get back to the unit 2 hours later just in time for my new patient to arrive with tons of orders. At this point I haven't even begun to chart anything. This is a typical shift in the ICU and I hate it. It is not for me. Last week I was given 3 critical patients two shifts in a row. Nice.

So here's where some advice would be appreciated:

My father was in the hospital over the weekend with pneumonia. He was on the floor. I went to visit him and realized how vastly different the floor environment was to the ICU. My Dad was still wearing his blue jeans in a nice private room and was able to get up and use the restroom or walk around at any time. I only saw a nurse come in briefly to check on him once while I was there. No need to continually watch him and be on pins and needles the whole shift. It seemed like such a contrast to the chaos of the ICU. I understand that floor nursing is very busy, but it just seems like it's a different kind of "busy." I would prefer the extra charting on 5 to 6 patients than to have to deal with just 2 ICU patients.

So, has anybody ever gone from ICU to the floor and liked it better? I know I can't stay in the ICU much longer. It is making me into a person that I don't like at all.

[Virgo_RN, BSN, RN]

I have not worked in an ICU, so I cannot speak to that aspect of things. But, keep in mind that my stable pneumonia patients are typically my easy ones, and I usually only have one of those, who tends to be "ignored" because my other three are more heavy. By "ignored", I don't mean that in a literal sense, but in the sense that I feel like I should spend more time with them, but I have to prioritize the sicker ones. I might not make it in to see them very often because I am hovering over two or three of my other patients. We don't have people on vents or pressors generally, but it's not out of the ordinary to have someone on bipap and to have patients on multiple drips such as Integrilin, nitro, heparin, insulin, diltiazem, furosemide, morphine, dobutamine, etc., with all the accompanying frequent vital signs and lab draws. I do recall from my med/surg rotation all the patients on TPN and lipids, insulin, and PCAs/PCEAs, which are all a pain in the patootie, IMO. Give me an antiarrhythmic gtt anytime, thankyouverymuch. I guess my point is that it's all relative. For you, the floor might be more comfortable than ICU. Personally, I like working with my sicker patients and would prefer to have two really sick patients over four not-so-sick-at-this-moment-but-could-go-bad-at-any-second patients, which is what we tend to get in cardiac tele. Sounds like you have some soul searching to do. Best of luck to you!

[SummerGarden, BSN, MSN, RN]

i have not worked in an icu, however i worked a tele step down and the label a few of us floor nurses give former icu family members is "icu-itis", so i get what you mean about being busy with 2 patients because those 2 patients end up being apart of my 5-6 patient load!!! on the floors, similar to the icu, patient condition dictates how much time we spend with our 5-6 patients. your dad sounds like he was not a problem patient and his condition was stable (not to mention you were not a problem family member with no clue about his current condition). thus, you saw the nurse a few times.

i think the busy you think the floors are is unrealistic. there is a reason we floor nurses hate the floors... trust me; it is not only because of the paper work... it is because we have to deal with a lot related to patient care, our patient loads are too big, and we have a lot of paper work. oh, and the same crazy family members you have to deal with, we deal with too.... they step down or transfer to the floors after being spoiled by icu nurses. and yes, i know icu nurses are doing what is necessary to provide safe competent care… i am just venting because it ends up adding to the amount of work and stress we deal with once we get them on the floors... those same family members are on the call light every other minute for the silliest stupidest things while we have patients who are very ill and actually need our attention.

in short, do not envy us….!!! we are busy with patients whose conditions are delicate too. we also have patients that need a million procedures done at once that are not cooperating and whose condition is progressively getting worse… at the same time we have at least two patients on the call light every hour on the hour for pain meds... i could go on... what you described regarding one patient in the icu you need to multiply by 6 minus the vent and a few drips (i admin some drips, by the way) to have some idea of what we deal with on the floors.

[Virgo_RN, BSN, RN]

i have not worked in an icu, however i worked a tele step down and the label a few of us floor nurses give former icu family members is "icu-itis",

the patients get icu-itis too. they are so used to having their nurse right there all the time, that when they come to the floor, they expect the same level of care, which it is not possible to give on the floor. heck, i'm beginning to think that the majority of patients and family members on the floor expect icu level care.

[Tait, MSN, RN]

1. First, take a breath, take a vacation and relax. :) I feel the same way, I am from the floor, and have started working with my manager to make sure each schedule I space my days off to give me a six-seven day break (i.e. Sun/Mon/Tue and then Wed/Thur/Sat the next week).

I also feel the stress of nights, and I am actually going back to school soon to complete my BSN and go into community/public health programming instead of floor nursing.

2. Get malpractice insurance if you don't already have it. Never trust that your facility will back you up in the end, just get it and at least have that piece of mind.

3. Shadow the floor. Things might not be as pretty as you think they are. I had an ICU nurse ask me once on a transfer how many patients I had back on the floor. When I told her five she shuddered and said "that is why we hate getting floated to the floor". Most med/surg floors are becoming closer and closer to step down units every day, without the support of staff and adequate patient ratios.

Best of luck! Trust me, lots of us are right there with you.

Tait

[classicdame, MSN, EdD]

This is one reason I think new grads ought not to go to ICU. I guess it depends on the person, though. Remember, you intended to be a nurse for the rest of your career. This does not mean you intended to have the same job on the same unit at the same facility forever. Give yourself a break. Go to another floor. You might be very surprised at how much you have actually learned. If you change your mind in the future, transfer again. Each experience will deepen your wealth of nursing knowledge and skill. GOOD LUCK

[sunray12]

i don't really know what i hope to accomplish by posting here, but i'll give it a shot anyway. thanks in advance for listening.

i'm coming up on one year since i passed the board and started off in the micu. my coworkers and supervisors have been great and very helpful at all times. however, despite the fact that i have recently become engaged and bought a house, i have become a different person. i dread going to work to the point of becoming sick to my stomach and do nothing but whine and complain to my fiance about my job. i worked as a pharmacy tech before and if it wasn't for the (slightly) higher paycheck, i would go back in a heartbeat.

....

^^in that case i don't see the point in becoming someone you don't want to be and probably jeopardizing your relationship over just a few extra dollars. money is important but it isn't everything.

[talaxandra]

Work is such a huge part of life that if you hate it this much you have to stop. The great thing about nursing is that every area is different - you can hate one area and love another. I am so grateful I trained in a hospital and got to rotate through a number of wards, departments nd specialties before making career decisions. ICU may not be for you; try something else. At least you have another career to fall back on but nursing may still work out.

Several colleagues have gone from the ward to ICU - 2 hated it and came back to ward work, one went into law, and three stayed there.

Good luck :)

[UM Review RN, ASN, RN]

There are more places to work than a hospital. Hospital experience translates very well to other areas. For instance, I worked on med-surg / tele and now I work for an insurance company. It's lots easier on the feet, and way less worries about lawsuits.

I think you should shadow a few nurses in other areas before you decide, but it does sound like you need a change.

Also, ICU skills are different, not better, than other areas. All areas have their own special challenges.

[PostOpPrincess, BSN, RN]

Your ICU background will go a LONG WAY in helping you with all your future jobs; and I disagree with above that says your ICU skills are not better.

They are; you will pick up on things everyone WITHOUT your background will miss. The little nuances, the changes in breathing patterns, the potential seizures, etc.

You will also NOT panic when someone codes because you've been there, and done that.

Hang in there until you find something that you are going to like. Remember that list with all the stressors? You have a BUNCH of them. Go to someone and talk to them; ask for their help (HR?) and figuring out how to destress your life. You will see once you communicate with higher-ups in a professional, non-whining, way they will try and assist.

It's more about retention now that anything. Good luck!

[tryingtohaveitall]

I don't think it's ICU nursing that is breaking you, but it sounds like your unit is unsafe. Maybe it is time to try something else but see what you're getting into first before going from the frying pan into the fire.

Hang in there, it will get better.

[nerdtonurse?, BSN, RN]

From the tele floor side of the house, we look at ICU and go, "only 2-3 patients?" I I know your guys are sicker, but here's what it's like on the floor.

Hit the door at 1845, pee, and get your patient list. Could be as high as 8 (worst night was 10).

Get report. And I've had to stop getting report at 1915 to admit a new patient, get finished admitting my pt, and the dayshift nurses are gone, so now I've got report on 2, admissions paperwork on 1, and no freakin' clue about 5. I go get the charts. Every single chart has orders written that aren't signed off in the chart, entered in the computer, or implemented. So I'm on the phone with the doc, sorting out 1x orders not given, therapies not started, calling pharmacy before they go home at 2100, etc. It's now probably 2030, and other than a fast nose in the door to make sure everyone's still breathing, I have yet to assess the first patient.

Start the 2100 med pass, and assessing at the same times. Usually I don't have a BP closer than 3 hours, so I'm also dragging the BP machine with me. Med pass can take anywhere from 30 minutes to 90 minutes. I've had folks who get *kid you not* 28 pills -- and the want to take them one at a time. That's fish out a pill, ask what it is (again), take a sip, put the pill in their mouth, take another sip of water, complain they don't have enough ice, have to stop to pee, want to take the next pill with a soda/juice, state "well, I'll take the orange one, but not the yellow one." -- all while you're just wanting to grab them by the nose and pour them down so you can go to the rest of your patients. Then there's PEGs and NGT feeders, q2 turners, q2/4/6 neuro checks for evolving CVAs. Usually by then, one of the sundowners is either trying to (or has) pulled out their IV/foley/NGT. Family is staying with half the patients, and they all want pillows, sheets, blankets. You've hopefully got a CNA, but sometimes there's just 1 for 30 patients, and you're doing all your fingersticks. It's now midnight, you haven't charted anything, and the charge nurse calls you outside a room to ask if you can take a 2nd admission, since other than her, I'm the most experienced person on the floor and she doesn't think the new kids can take another pt. And if you've got someone like I had last weekend (dying endstage COPD) they are calling you to their room every 30 minutes. If you've really got someone who's going down the tubes, (CVA extends, has an MI on the floor, pops their abd. stitches, loses bowel sounds and starts puking bowel contents), you get even further behind.

There are nights where I don't finish putting in my original assessment until almost 0600, nights where I don't get to pee except maybe twice, don't get to eat, chug a juice because my sugar's tanking, and barely get everything cleaned up for dayshift -- orders signed off, meds in the computer, calls made to pharmacy about incompatible meds being ordered IV in a patient at the same time who we can't find a vein in. About 0640, here comes anesthesia wanting to put in TLCs, PICCs, do a thorocentesis, etc., and wanting you in the room -- usually 2 rooms at once.

I think what you saw with your dad is what I call an "autopilot patient" -- alert, oriented, ambulatory. They're lucky if they see me 3 x outside the med pass. Most of my patients aren't on autopilot, and if you come out to the floor from ICU, you're going to get all the "fresh from ICU" patients because of your work experience. So think about how sick the folks you send to the floor can be, and imagine having 5-7 of those, with a nice projectile vomiting, full urinal hurling off the chain pt in the DTs into the mix.

I just don't want you to jump out of the frying pan and into the fire. To give you an idea, our ICU nurses WON'T work tele because they say they can't take the pt load, to the point where they all went to their boss and got made a closed unit so they couldn't be pulled.