Stress level on a neuro floor

86toronado, BSN, RN · Nov 28, 2009

I've only worked on neuro, and cardiac, but I find that neuro can be more stressful physically, since most of your patients are full care patients that require the majority of their ADL's done for them-feeding, bathing, turning and positioning, etc.

It can also be alot more mentally taxing, since you are dealing with alot of patients who have communication deficits... imagine a patient is trying to tell you something, but is aphasic, so her words are coming out like garbled nonsense. In the meantime, you have 5 other patients who need your attention, but can't leave this patient until you know what she is trying to tell you. It can be incredibly frusterating, and that's without even getting into the family involvement...

Or, the classic alzheimers/dementia patients. You have a long talk with them regarding their foley catheter and why they need it, and why it is very important that they do not pull on it. They state that they understand. You leave the room. 15 minutes later you go back into the room, and they hand you their foley catheter, stating "I can't get this remote to work the television." That can be stressful.

As far as comparing to ICU, I think physically it is about the same, since ICU patients tend to need all of their ADL's performed for them as well. Mentally, I guess it depends on your sense of humor. I personally love my neuro patients, and wouldn't have it any other way!

mh356, BSN, RN, EMT-B · Dec 31, 2009

I did 2 years on a med surg/tele unit before switching to a neuro IMC. I found that med-surg was much more stressful because of all the admits/discharges, patients that went off the floor (to smoke, etc.) and going off to tests. Hard to keep track of 5 patients.

3 IMC pts are no walk in the park either, but I am a lot happier in neuro.

CoolKell10 · Jan 5, 2010

I started on an ortho/neuro floor after graduating from Nursing school. I've been on this floor for a year now. Our neuro patients consist mainly of those who have had lumbar, thoracic, or cervical spine surgeries, as well as, cranis, etc. We don't get very many dementia patients unless they are just elderly and happen to have a little bit of that going on along with their back problem. I feel like when I take care of more neuro (back) patients then the orthos I have a much more stressful and hectic night. I blame most of that on the fact that the back patients have been on HUGE amounts of narcotics for longer then I've been alive and have built up large tolerances. It is very hard to control their pain even after giving them pain meds, anxiety meds, muscle relaxers, and sleeping pills. Then you call the doc to get more meds and it still doesn't do anything. It's just hard to deal with those patients who are hurting that badly (or atleast say they are) and won't get up and walk or do anything for themselves. Then walking is another issue because many of these people need assistance ambulating. Let's say you have 6 patients, and 4 of them need assistance walking and some may take 30-60 minutes to get them out of bed and walk them...well that's a lot of time spent just on that. It would be easier if my floor had more CNTs but we only have one for 37 patients so she is unable to help with that most of the time. So yeah...I would say neuro is VERY stressful.

missninaRN · Jan 5, 2010

I worked on a neuro med/surg floor for 16 months with pt load of up to 7. I didn't find caring for neuro patients to be any more stressful than the medical patients (pneumonia, COPD, GI bleeds, etc).

What I found stressful was the constant flow of discharges and admits associated with neuro patients. Most of our healthy, uncomplicated laminectomy and ACD patients were discharged within a day after surgery and our surgeons did several of these surgeries each week. That took a lot of time away from patient care, which is always stressful.

vivacious1healer · Jan 14, 2010

Yes, our Neuro floor can also be very stressful.

We take on everything from little old lady with dementia to the fresh craniotomy with EVDs, and monitoring their ICPs, and then the seizure section part of the unit where patients are purposefully taken off all meds and we want them to have a seizure.

Its a busy place, broken into 3 sections: Neuro step down (monitored patients), regular neuro (hopefully stable patients) and then the seizure unit (video/audio/EEG recorded).

Now when I get floated to another floor, i know I can handle it, because our unit is known to be the most difficult in the hospital. So, I can see that as the upside of working neuro.

tewdles, RN · Jan 14, 2010

Every specialty area has it's own unique set of stressors for nurses.

The fact that you are only 6 months into this unit is, all by itself, stressful. When we change specialties it takes a minimum of 6 months typically to feel like we are not a danger to our patients. It takes about a year to feel proficient as a nurse in the department.

Hang in there, stay connected with your peers and preceptors. You will come out good on the other side.

dragonflyaltoids · Aug 1, 2010

I come with 2 years of ED experience and 1 year of neuro experience for me, the 6 :1 neuro ratio is very frustrating the constant it feels almost like babysitting the closed head injuries with trachs that are in traction and halo's that need 100% adl's and have to get out of bed daily and the little old lady with the cva that has right sided hemiparesis whose family thinks she's going to be 100% her old self is very frustrating! Give me the trauma any day! I love the people I work with and the day shifts, and seeing most of them get well, but some of alas, go meet GOD in heaven but its their time, we just prolong it so they may have a few more weeks with their families and that's all they want, and that is enough for me.

I ask them when they get there, what is your goal Mr. So and So.. Do you want to Walk? Eat regular food? Get out of Bed? Breathe without oxygen? I will do my best to help you achieve one babystep a day, and day by day we will get there! Some say I just want to take a shower its been 32 days since I've had a real shower, and in that case, I go get respiratory, a portable vent, crank the heater in the room, turn the shower on in the big shower room, get the shower bed, put on my extra scrubs, grab the tech, and the three of us, the tech, rt, me, and the pt, go and shower the patient, hey if its the last thing the patient wants while they're alive, I'm going to give it to him! I had one patient going home with hospice, he found out I used to be a hairstylist and he kidded about needing his haircut, I had my scissors in the car, my boss still doesn't know but I brought them in, threw a sheet on the ground and trimmed him up 2 days up before he went home! His wife was so happy! I love my patients, its little things like having the TIME to do NICE things that make the JOB rewarding... I just wish I had more of it. *sigh* Thanks for listening to my rambling...

MochaNurse · Aug 18, 2011

Hi all,

Thanks for all the post I am a new grad RN, I just started on a neurosurgical unit in Albert Einstein Hospital in the Bronx on Tuesday and I feel like Im lost..Is that normal? It is alot of work that I pray to master one day soon.....I felt very overwhelmed when the day was done...there is so much to do for each patient and to learn..I feel like Im in school again getting ready to take my unit exam....Please help with any advice, It would be greatly appreciated..I feel like Im all alone? Has anyone else felt this way when they started their first nursing job..Do you guys have any tips that can save my job..My probation is about 3 months and I would love to pass it...I love nursing so I want to do my best!!!..Thanks in advance!!!

Mocha Nurse

ruralgirl08 · Aug 18, 2011

After you are in a year, you will feel less overwhelmed. I would suggest building very good teamwork skills, offer to lend a hand, with turns, vitals, ect. It is a heavy population. You will remember patient safety is #1, even though it may mean having to restrain someone to keep them safe. You are not being mean. Neuro is definitely unusual, always the unexpected may happen. It is also very sad, at times when people lose part of their identities due to disease. Their personalities can change a lot with brain injury. People have alot of difficulty coping with losses of function, and so do their families (stroke, Guillain Barre, ALS). You will learn a lot of valuable skills here, and see a lot of unusual things you don't usually see on regular med-surg floor, and it will be useful, wherever you end up taking your career.

informaticsBee · Nov 10, 2011

I remember being a new grad on a neuro floor. It was very stressful b/c your working with all sorts of patients. I felt that working on a neuro floor actually is very helpful with working on any other floor. I think the stress comes from the overwhelming about information you have to learn. But with other staff and leadership support, things should start coming together.

Munch · Nov 23, 2011

Oh absolutely! I work on the neurosurgery/neurology unit two days a week for 12.5 hours and the oncology unit for one day a week for 12.5 hours. I do enjoy a 3 day work week but back to the statement at hand. I don't know if you just work on a neurology unit or if you work the both combined neurology/neurosurgery unit.

Like you said all different kinds of patients with all different diseases and surgeries: Parkinson's disease, fractured skulls, MS, microvascular decompression's(which involves a Craniotomy), Aneurysms, Benign tumors(cancerous tumors go to oncology), brain bleeds, strokes and so much more. Not to mention the pain medications, antibiotics and other medications that go with the diseases and injuries