signs of a bad unit

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I'm a senior nursing student who also works in a hospital and I'm looking for some advice. I will be graduating in the less than a year , I have started to look at options for future employment. I have been floating to different units and I have seen drastic differences between the different units. I'm not looking for the perfect unit , but I'm looking for one that tolerable and one that I'm comfortable at working in. Any advice on signs of a bad unit and things that should not be tolerated?

As I have repeated over and over a lot of newer nurses (1-3 years of experience) move on to NP school or grad school in general.

My ICU (general MICU) is largely people under 1 year experience and those precepting are usually barely above that. We use travellers heavily.

We had a few nurses with 20+ years of experience but they left or went into our virtual ICU.

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Your hospital is well-funded and staffed. Most places are not like that.

Actually it not, most of the time they do not have a tech. If they do have a tech, its only one tech for the whole floor. A good portion of time when i float to the ICU , I get pooled off the floor to sit with the patient, leaving the unit with no tech. Because of the high turn over rate the ratios are 3:1 or 4 : 1 which is very dangerous for a nurse.

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Actually it not, most of the time they do not have a tech. If they do have a tech, its only one tech for the whole floor. A good portion of time when i float to the ICU , I get pooled off the floor to sit with the patient, leaving the unit with no tech. Because of the high turn over rate the ratios are 3:1 or 4 : 1 which is very dangerous for a nurse.

An ICU with 4:1? I have never heard of that unless they aren't REALLY ICU patients. There's no way.

Like I said techs AT ALL besides 1:1 are not the norm.

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Specializes in Med-Surg, NICU.

I work on a bad unit.

1. Excessive use of travel and agency nurses

2. New grads outnumber experienced nurses

3. New grads placed in charge (!!!!)

4. Extremely high turnover.

5. Nurses being forced to work as sitters/aides AND carry a patient assignment as a nurse

6. Being called nearly every day to pick up shifts

7. Needing to give nurses sign on bonuses or bonuses for picking up extra shifts

That is just off the top of my head. I am sure there are more.

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An ICU with 4:1? I have never heard of that unless they aren't REALLY ICU patients. There's no way.

Like I said techs AT ALL besides 1:1 are not the norm.

There are very true true icu patients, the floor has a very high turnover rate and not a lot of options to bring in staff. You mean sitting with patient is not a norm? Then thats a shame, when I sit with a patient, they genuinely need a sitter. If we had to call a code green ( aggressive patient) then patient needs a sitter especially if they became so violent that we had to give them an IM. Im not sure where you are but patient sitting is very common in the hospitals around here. It part of the protocol to have a sitter if certain events occur with a patient.

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Specializes in ICU, LTACH, Internal Medicine.
I work on a bad unit.

5. Nurses being forced to work as sitters/aides AND carry a patient assignment

That is just off the top of my head. I am sure there are more.

Dear Lord....that is very bad indeed. Especially as a sitter... how can you physically be in more than one place at once??

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Specializes in Med-Surg, NICU.
Dear Lord....that is very bad indeed. Especially as a sitter... how can you physically be in more than one place at once??

You can't. We have had to abandon sitter cases due to ERTs and codes. We have had patients fall because the nursing staff was being forced to sit.

It is SO dangerous.

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I work on a bad unit.

1. Excessive use of travel and agency nurses

2. New grads outnumber experienced nurses

3. New grads placed in charge (!!!!)

4. Extremely high turnover.

5. Nurses being forced to work as sitters/aides AND carry a patient assignment as a nurse

6. Being called nearly every day to pick up shifts

7. Needing to give nurses sign on bonuses or bonuses for picking up extra shifts

That is just off the top of my head. I am sure there are more.

Do you work at my hospital because we have all those things?!?!?

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Can't say I've seen too many "good" units. The one I started on was almost all new grads and a few disgruntled experienced staff who were completely disrespected/under appreciated by management. Sure didn't make me want to stay there! Sometimes I feel like nursing is in a state of emergency, although we somehow always get by. We are too resourceful for our own good!

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Specializes in CVICU.

I think I work on a 'good' unit, so perhaps this can provide some perspective. For the record, I work in a CVICU.

  • We always have a unit secretary, on both day and night shift.
  • We always have at least one tech, usually two.
  • Nurses are never tripled.
  • Very sick patients such as fresh open hearts, therapeutic hypothermia patients, and IABP patients are 1:1.
  • The charge nurse never has to take a patient so they are available to help if needed, and are very good about doing so. The charge nurses round frequently to make sure we (staff nurses) do not need any help.
  • We (nursing staff) always ask each other if help is needed when our own patients are taken care of.
  • We almost always have time to take a lunch break, since even if you have very critical patients, nurses who do not are willing to watch yours while you run to the cafeteria.
  • Around shift change, if we notice another nurse is very behind, we'll do things like get their patients up into the chair, empty their foley bags, mark and chart their chest tube outputs, make sure their patients don't need anything, give any unpassed meds etc so they can catch up.
  • When the morning staff gets there, the clinical lead usually rounds to make sure none of the night shift nurses need any help finishing their shift.
  • When we get an admit, the charge and at least two other nurses or a nurse and a tech are in there with you to help get your patient settled: put them on the cardiac monitor, get a blood pressure, get height/weight/temp, get them into a gown, give them a quick bed bath, and other necessary things we do to all admits like screen for flu vaccination etc. This is so you can quickly assimilate them into your care so your other patient doesn't get neglected while you try to get them settled in.

I think a lot of what I mentioned centralizes around simply having good teamwork, which is necessary in any area of nursing but especially in critical care. Either your unit has it or they don't.

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Specializes in ER, progressive care.

Listen around. If the nurses are always complaining about how much the unit sucks and how much they hate their job, STAY AWAY. A high turnover is also a bad sign. Some units are also known to have a higher turnover than others, such as ICU and ER. That doesn't mean all of those units are bad, you just have to look at other factors, too. There's a lot of great advice in this thread.

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Specializes in ER, progressive care.
I work on a bad unit.

1. Excessive use of travel and agency nurses

2. New grads outnumber experienced nurses

3. New grads placed in charge (!!!!)

4. Extremely high turnover.

5. Nurses being forced to work as sitters/aides AND carry a patient assignment as a nurse

6. Being called nearly every day to pick up shifts

7. Needing to give nurses sign on bonuses or bonuses for picking up extra shifts

That is just off the top of my head. I am sure there are more.

Sounds nearly identical to my unit!

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