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?

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.

Your unit sounds pretty good , the big theme with your unit is teamwork. I have seen some units allow the petty drama cause the staff members not to work together causing poor patient outcomes.

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Turn on call light and see how long it takes for someone to get it.

See if there is teamwork.

That's my two cents on hospitals...

Now for nursing homes I can give you a whole list ranging from in house acquired wounds and infection rates, cleanliness of the the floors, compassionate and skilled nursing attributes etc

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Specializes in Oncology.
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.

That's INSANE. That's our step down units' ratios and it seems unsafe frequently if it's 1:4. You cannot adequately monitor/care for 4 vented, sedated, paralyzed patients on multiple pressors, requiring frequent blood draws and blood products or extensive dressing changes.

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Specializes in Oncology.
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.

If you could just PM me your hospital's address and an application, that'd be great. I'll be on the computer, updating my resume, and waiting.

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Your unit sounds pretty good , the big theme with your unit is teamwork. I have seen some units allow the petty drama cause the staff members not to work together causing poor patient outcomes.

I have worked on a few units in my career and I can tell you it's easy to have good teamwork if you are well staffed. There is less stress and more opportunities to help.

People can only do so much. Sure drama is everywhere but what the previously poster posted about how her unit is a well oiled machine is no fluke. It's like that because of staffing and resources, period.

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CNA's not taking orders from nurses. Red flag.

Another one is if nurses are doing CNA work (ie changing diapers, toileting patients)

You might think the second one is the product of the resources you are given, but I firmly believe that if a workplace isn't giving you CNA's, then it isn't worth the time or effort to stay there.

BIG red flag-this reflects directly on nurse manager.

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KatieMI you're right on cue. I recently worked on a unit and it was "all of the above".

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You're in a good (and rare) place.

Your unit sounds pretty good , the big theme with your unit is teamwork. I have seen some units allow the petty drama cause the staff members not to work together causing poor patient outcomes.
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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
*High turn over

*Poor ratios that aren't adjusted for acuity

*Poorly visible management

*Poor communication between physicians/management/nursing/auxillary staff

*Either all new staff or all old staff

*Running out of basic supplies- linens, IV pumps, bandage supplies, etc

I'll agree with you on all but the first. High turnover isn't always the sign of a bad unit. Sometimes -- and this has to be evaluated on a case-by-case basis -- the unit is a "feeder unit" for the nearest CRNA schools. In that case, you'll have a core group of senior staff, a bunch of 1-2 year staff who are all applying to anesthesia school (or PA school, NP school or travel companies) and the rest either on orientation or 6 months or less off orientation. If you find a unit with that staffing/turnover pattern, look for visible management, communication between staff, ratios and supplies. If everything else is all good, use your shadow time to ask staff about their plans for the future. If they tell you they're planning to go to school or become a transplant coordinator or some such, it's probably all good. If they're just looking to get OUT, probably not so good.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I'm also a bit concerned when I see a lot of new grad nurses in high acuity area. I wonder who they can get guidance from if a good portion of the staff is new themselves.

Look for a core group of senior staff. There will be bunches and bunches of newbies, to be sure, but most shifts will have 2 or 3 or more senior staff. A few senior staff -- one in charge and two or more spread out through the unit -- can serve as mentors and resources for all the newbies. It helps if the newbies are willing to be mentored.

Ask about orientation and who your preceptors are. You want at least two main preceptors, three at the most. Our pattern is one senior preceptor and one relatively new nurse (about two years) who is just learning to precept. The new preceptor solidifies her knowledge of nursing and the patient population while teaching and at the same time the senior preceptor guides both the new preceptor and the orientee. It's an effective use of senior staff. And you'll get a fairly good orientation, as long as the new preceptor isn't full of herself and is willing to be mentored.

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Specializes in Oncology.

Very true. Good asterisk on the first point.

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I'll agree with you on all but the first. High turnover isn't always the sign of a bad unit. Sometimes -- and this has to be evaluated on a case-by-case basis -- the unit is a "feeder unit" for the nearest CRNA schools. In that case, you'll have a core group of senior staff, a bunch of 1-2 year staff who are all applying to anesthesia school (or PA school, NP school or travel companies) and the rest either on orientation or 6 months or less off orientation. If you find a unit with that staffing/turnover pattern, look for visible management, communication between staff, ratios and supplies. If everything else is all good, use your shadow time to ask staff about their plans for the future. If they tell you they're planning to go to school or become a transplant coordinator or some such, it's probably all good. If they're just looking to get OUT, probably not so good.

I worked on a unit like this. It was NOT a bad unit, but I ultimately didn't like working where people were constantly leaving and constantly on orientation - so I changed to a unit with less turnover.

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