SICU with No Surgery Patients :(

[chordringer]

Hey everyone,

I work in a SICU at a mid-level 400-500-bed hospital in an urban area. Our hospital is a teaching hospital and has the 12-bed SICU I work in, a 12-bed MICU, and a 10-bed CVICU/Step-down Overflow. Since late March, our unit has experienced persistent low census of SICU patients. It's gotten so bad that our unit has actually been closed four times in the last 3 months. The patients that we do get aren't very sick and usually transfer out in a day or two. We've actually taken quite a number of stepdown patients just so we can stay open. While all of this has been going on, my colleagues and I have been persistently floated far and wide, low-censused, and put on standby. This has resulted in several of us having to deplete our PTO bank just to subsidize a full paycheck.

Administration says we're just in a slow period, but some of the nurses that have been around for 10+ years say that we have never had a time period in which the SICU has closed more than once and even then it would be closed only for a day, not a week at a time like we've had recently.

I attribute this problem to less and less surgeons doing surgeries at our facility. Our entity is the oldest in our healthcare system and I think a lot of the docs are opting to take their cases to the newer facilities in the system located more in the suburban areas. Some of the more tenured nurses on our unit have said that we used to have nearly 10-12 docs doing surgeries every week... and they were from a variety of specialties. These days all we get are the occasional fem-pop, carotid, and colon resections.

I was curious to know if anyone else has dealt with this and whether this might be foreshadowing of things to come down the line. What is the best way to approach the employer with concerns about this. I like my job, but I worry about the sustainability of this if it continues.

[Candyn]

It is weird for a teaching hospital to be this slow. Is it a teaching medical school type? My hospital is super duper busy.

[RNGriffin]

I work in a teaching hospital, and while low census is not abnormal; to have low census records for 3 continuous months is in the abnormal range. I have seen two units in our facility closed down to the lack of demand or patient necessity. If you like the facility you work at, you could jump ahead of the curb & start applying internally.

I wouldn't make a definite answer in regards to the stability of your position. But, time will tell in the next couple of months. If the CEO/COO continues to see this continuous decline in patient necessity, it could very well mean the budget will be adjusted to reflect the need.

[BOSRN]

I work in a ~1000 bed level 1 trauma center and we're experiencing the same issues. The acuity and census has dropped drastically over the past year. We've been taking on Neuro borders and keeping patients for way longer than needed just to keep our census up. Now its becoming more common to discharge a patient home from the SICU. There's many nights when we only have 1 or 2 patient's so we float to other ICUs or we have to take our PTO. That can leave only one nurse staffed to run the whole ICU! To save money the hospital is now "flexing" nurses down to 50% of their weekly pay, basically the nurse gets called out d/t low census but is not allowed to take PTO. A lot of our staff is now looking for more stable jobs either internally or per diem at other hospitals.

So you're not the only SICU this is happening too. Nationwide there's less elective surgeries and more people delaying or seeking alternative/cheaper treatments. We joke around that there's also less people driving recklessly and shooting each other because our trauma admits are also way down! I'm not sure the solution to the problem, but our older nurses say SICU always goes through these lulls.

[Creamsoda, ASN, RN]

I would be searching for something internally just as the MICU, I'm sure they tend to stay fuller due to elective nature of surgeries sometimes. Start planning now so you don't get burned in the end.

[Candyn]

What states are you guys in? I am not working in ICU and only started working recently but according to what I see my hospital is busy. But it maybe slow but I just do not know. I agree with you guys tho, 3 months on the floor and I only see one elective surgery.

[jajajody]

What states are you guys in? I am not working in ICU and only started working recently but according to what I see my hospital is busy. But it maybe slow but I just do not know. I agree with you guys tho, 3 months on the floor and I only see one elective surgery.

I am an old ER nurse who transferred to interventional radiology/angio 6 months ago. I am not so surprised to hear that SICU census is down considering all the embolizations of traumatic organ injuries that we perform on trauma patients. Not only does this cut down on the need for surgery but is shortens length of stay in SICU.