stress in er and icu

Iam46yearsold · Sep 15, 2008

Also would like to agree with the poster who said ER was more stressful. I think it depends on the ER and the person,but mostly it would be true for me as well.
ER you have no idea what kind of day you are going to have and if you are going to have a bad shift in ICU you tend to know right of the bat alot of the time and can at least mentally prepare. ER is too much of an uncontrolled environment if you ask me. Actually since I have gotten fairly adjusted to ICU, I could not handle to work in the ER or Med-surg for that matter. I turn into an unorganized mess when you give me more than 3 patients....

But the floor is a different kind of stress, and I dont understand it. Now ER is the horse Ive ridden for a long time now and I have it well broken to the saddle I wear.

Roy Fokker, BSN, RN · Sep 15, 2008

Someone once mentioned that "ER nursing is jack of all trades, master of none". He meant it as an insult but I took it as a compliment. I truly cannot emphasize enough as to the whole deal behind "you never know what's rolling though the doors next".

Because you never really do.

And the folks who present themselves to you are complete mysteries. Their condition is as yet undiagnosed and most folks are not very relaible historians (seriously, the more I work in the ED the more I think House is right when he says "everybody lies").

You have no idea as to what's really going on with them. If I had a hundred dollars for everytime some one came in walkie-talkie c/o of vague complaints or fatigue with normal neuro assessment ... and their CT showed massive head bleeds; I could have retired by now with a summer house in the Hamptons & a 1000-foot yacht! lol

3 day old babies to 105 year old grannies. You name it, we've done it.

Because of this varied population and also because you're the first stop for anyone and every one when ever the fecal matter hits the air circulating device, you can never become truly "comfortable". You think you're settling in and getting the hang of things and then BAM! Something truly bizarre shows up (i.e. "what the **** is that thing sticking out of his eye?!!") and you pray and hope that there is someone else more experienced around who may have seen this before.

But some days, you're that person and let me tell you, it can get real hairy making snap decisions on the spot.

It's what I love about ER though. As morbid as this sounds - I'm an unrepentant trauma/adrenaline junkie. Traumatic amputations, multiple vehicle MVAs, blood, body parts and fluids everywhere.... ahhh! I'm in hog heaven :smokin:

cheers,

Pester1 · Sep 20, 2008

Would some tell me what a usual day is like in the ICU?

Maco · Sep 29, 2008

One thing is for sure....I do not want to work a 12 hour shift and every hour that passes it feels like eternity. One thing I can say about med-surg floor there is not enough time in the shift to do all that needs to be be done. Before ya realize it, its 1800 and you still have meds to pass and end of shifts to do...then you find out you"ve got a new admit coming. Does time fly by in icu and er....I realize it depends on your patient in icu and with er there is no way to tell...but on norm/general days. Also somedays I feel like all I do is pass meds all day lone. I feel as if I don't use alot of those critical thinking skills taught in school...because its all I can do to just get my meds passed out on time...does anyone else feel that way on med/surg floors.

vivere · Sep 29, 2008

ICU stress is a little different in that lots of the time you already have a picture of the systems that are off balance, so you can anticipate what may go wrong....but there are no absolutes. One thing I do love about it....many times the staff will see the patient, vented, on all kinds of critical drips, a DNR, and you can come back to work a week later and the patient is sitting up talking to family members! It never ceases to amaze me. I might also mention that it matters a lot who you happen to have working with you. I am often staffing with the same two or three people, and it can be a terminally long night if someone is depressed or mad at one of the others for whatever reason. Some nurses don't have the ability to leave their problems at the door. Others sail through the night and you never know how bad they have it at home. :redbeathe

vivere · Sep 29, 2008

Pester, I started out to tell you what my day might be like. On day shift, we come in and take report from the offgoing staff. It also is imperative that you scan the unit by yourself, and take note of any potential problems that might come up. This can be done quietly and without a word. I ALWAYS check on my assignment before the prior nurse leaves. She may have forgotten to tell me something (This happens a lot!) or I may need her help to turn or clean my patient, or just reposition someone. We have beds that will actually help us turn the patient, but it still is helpful to have assistance. During report I try to write down everything the nurse tells me. The reason for this: I am using my ears as well as my writing to take report, and it sinks in better/ We look at the recent orders written by the MDs and we also scan the medication sheets. Two sets of eyes are better than one. Even with all of this checking, people still make mistakes, whether it be missing a medication or forgetting an order. Don't ever take for granted that the RN before you has done everything right. After this, I go in and even if my patient is unconscious, I introduce myself and tell the patient about my plan of care for the day (or night). I then do my complete assessment, set my monitor controls for how often I want my vital signs, and I start running. It takes almost the whole shift to get all the charting done. Critical labs are reported to me, and I must call the MD within 30 minutes to have it addressed. That brings me up to medication administration time. All meds have specific times when they are given, and I have 30 minutes leeway on either end to give them. In the meantime, the docs will have already come in and given new orders. Hopefully we have a secretary to transcribe and place them in the computer, otherwise, the job is also mine. Then family arrives. You introduce yourself, give a quick update after verifying their identity, and take them into the room. If it is a new situation, or something has changed I explain to the family what is going on. Families really respond well when you tell them as much as possible, in terms that they can understand. Around lunchtime, if possible I will run to the cafeteria and bring something back to our kitchen to eat. I have 30 minutes to do this. After lunch, there are usually more medications. The patient will need to be cleaned up. During the shift, oral care is given every two hours, and the vent patients need to be suctioned as well. Respiratory therapists at my hospital handle this, and they are invaluable helpers with the ventilator patients. Charting is done every hour pretty much, at the least. Some let it go for every two hours, but that's too long for me.

During the a.m. and afternoon, tests may be done on the patients. If it is a CT scan or MRI, the patient needs to go with a monitor attached, and I will need help transporting my patient and his equipment and drips. Towards the evening hours, again, there are medications. All IV fluids and lines must be labeled with the date they need to be changed. Family visits again, and then I start cleaning up the patient again, and the room and work area, so that all will be ready for the next shift. I add up all my intakes and outputs and ...whew! I forgot. In the am., the different disciplines who work with the patients will come around to review with you what is going on and the plan of care. This generally with be MD, (if you're lucky), nutritionist, physical therapist, case manager, etc. They expect you to give a rundown on the whole picture from admission to the current day.

Well, that's a typical day for me. I'm tired already! But the good part is, usually I will only have one or two patients, and I love taking care of people who need my assistance on the road to wellness. What do you think? At the end of my 12 hour shift, I give report to the next staff member, going back again to the initial admission, the history, and what is going on now with the patient. Family dynamics are also important .

Good luck! It's been a great career for me. I went back to school after being a housewife, and nursing has helped me get out of debt and get my own house.

vivere:yeah:

L1TraumaLPN, LPN · Oct 3, 2008

I am an E.D. (er) LPN, and I can't live w/o the stress !!! Call me crazy, but I love it. I would never go back to med-surg nsg. I left the E.D. and worked a clinic for 3 months and thought I'd die of boredom, so I picked up E.D time after my Clinic hrs. then ended up back in my full time E.D. position.

Iam46yearsold · Oct 5, 2008

I am an E.D. (er) LPN, and I can't live w/o the stress !!! Call me crazy, but I love it. I would never go back to med-surg nsg. I left the E.D. and worked a clinic for 3 months and thought I'd die of boredom, so I picked up E.D time after my Clinic hrs. then ended up back in my full time E.D. position.

I love ED also, but if we love it is it truly stressful. Doesnt love negate stress. I feel it does.