I work in a newly formed Neuro ICU with a no one physician in charge, we have neurosurgeons, neurology and a medical team all writing orders and making care suggestions. We've had SAH patients on q1 full nihss for 21 days if they are having vasospasms, with multiple trips to CT once they become delirious, because they will no longer participate in the stroke scales because they are tired, frustration, and delirious. It seems like a fight to even get them at 4 hour break between 11p-4a, and that took the patient hitting a neurosurgeon cause he sternal rubbed them. Its chaos at best in our unit even after 2 years. At this point the few experienced nurses left have started doing our education and taking research to the physicians to try to force some consistency.