Well, with regard to making Medical Surgical suck less my advise would be California where at least the ratios are set by law to no more than four to one (3 to one in PCU). Also, their mandatory lunch breaks probably help in ICU. Someone above commented at the challenge of "eating lunch" after cleaning a body. Well, in the ten years I've been at my HCA facility I've been able to take maybe 10 lunch breaks (although we must clock out) since there is no one to safely watch your patients. Rather the routine is "patient dies, rush the family through the mourning process... move the body, so that you can get another body in the room". No to turn this into another "need for mandatory staffing ratio's thread", but California's law is the answer for many of the problems that you face. Only someone who is a sociopath, or very disassociated can not be emotionally disturbed working in the ICU where I work (in my case most people including my significant other say I have Asperger's so my manifestation of emotions and social interaction(s) may be blunted, but I certainly feel them).