Stress levels in ICU/CCU

Christie RN2006 · Apr 6, 2009

The ICU can definitely be very stressful, but it tends to be a different kind of stress than a med/surg floor. In the ICU, you will generally have only 1-2 patients, but they will be very sick with multiple drips, drains, vents, monitors, etc. Sometimes the most stressful part is dealing with a critically ill patients family...

As for me, I would much rather be in the unit with multiple drips than be on the floor with multiple patients!! I would prefer a crazy night in the unit over a crazy night on the floor almost any day! I know some nurses that can't stand the unit, they said that they don't like having to titrate drips, work with all of the machines, and deal with the families in the ICU setting. But give me a vented and sedated patient and I am happy

It's all about what types of patients you like dealing with! If you are seriously considering a move to the ICU, as the manager there if you can shadow a nurse in that area so that you can get a feel for what it is like.

McBx3 · Apr 6, 2009

I'm glad you posted this, because I was wondering the same thing!

Bella RN, BSN, MSN · Apr 6, 2009

Yes, I agree with Christie. It is a different type of stress. But I would much rather have multiple drips, and vents and dealing with the families and docs in the unit opposed to dealing with the multiple patients on the floor.

One thing that i notice is due to such heavy patient ratios on the med/surg floor your likelihood of catching a potential "at risk" rapid response or code patient is low because you guys don't really have the time and sometimes the resources on the floor to assess the patients. Its robotic and with 8 lives on your hand you have to hustle and bustle and don't get the time to see the broad picture of what may be going on with a patient.

I really wish that the new administration could place a mandate on patient acuity and ratios in hospitals. But then if we lowered the ratios;we don't have enough nurses..It is such an awful dilemma. :banghead:

I know you guys work hard and I see in your eyes your hard work and effort and fear when I get a patient that is crashing come to me from the floor. I wish I knew the answer and the way to make a difference.....still thinking about it. :saint:

I personally feel that a med surg floor should have 4:1 ratio a max of 5:1. Ratios like that you are able to assess the patient and get a better understanding of the plan and a broader picture of the conditon. Much better out come and better care will be provided. But 8 or 9 that's like treason:cry:

UM Review RN, ASN, RN · Apr 6, 2009

Go for it, I think you'll like it.

You can do some things to prepare yourself right now by getting familiar with tele www.skillstat.com and getting your ACLS. The new provider guide comes with a CD so you can test yourself. http://www.amazon.com/Provider-Manual-American-Heart-Association/dp/0874933277

You can also get your stroke certification online:

http://www.strokeassociation.org/presenter.jhtml?identifier=3023009 (That last one takes a few hours to complete, but you'll see it a lot.)

RNperdiem, RN · Apr 6, 2009

A few patients in the ICU are trying to die, some are unstable, but most are pretty stable by ICU standards.

Since I work per diem, I get more than the usual share of people hanging around in the ICU as stable vent patients, so my view of ICU may be distorted. I haven't had a patient die on me in 7 years.

Plan on your stress levels not to improve after switching from med-surg to ICU, at least not right away. Learning a new speciality brings its own stress.

oramar · Apr 6, 2009

My experience with ICU was that it had two speeds, extremely busy to the point of being overwhelming and slow. Yes it can be very busy but the my limited experience was that it had times when nothing much was happening, there did not seem to be any speeds in between very busy and slow.. Med/surg had two speeds also, busy and crazy. That is what burns you out on med/surg, the busy never, never stops. If anything changes at all is that things go completely nuts once in a while. But I have to tell you it is 10 to 15 years since I worked in ICU and two since I did med/surg so maybe I remember med/surg as being the busiest because it was most recent.

interleukin · Apr 6, 2009

IMHO, the worst stress comes from dealing with a sick patient knowing that your other patent is as sick or becoming sicker.

What do you do first?

What's happening now in the other room?

You know you should be there, one on one, and yet you have another separate universe of issues and problems in this other room.

One patient is medical, the other surgical, so each team is giving orders unaware of the burden the other team requires of you, as if you were their nurse alone.

How do you juggle this?

How do you reconcile with the family that their sick loved one is monitoredas carefully as you'd like?

Too often the care that hospital missions statements proclaim they provide could only really be achieved if we had only one sick patient(not a sedated 85 year old nursing-home repeater who only need turns, mouth care and meds, and is only there because of the vent.)

ICU stress comes from knowing you can perform best-care practices to only one patient at a time.

Med/surg stress comes from the enormity of tasks and duties that must be performed every day in a finite period of time, all the while praying no one deteriorates in a way that is not severe enough to ship them out.

soulofme · Apr 6, 2009

Im wondering if I could find a chronic dialysis unit that sedates its pts??? :yeah:

lfdelarosa · Apr 6, 2009

Go to the unit! I worked tele for two years before i transferred to surgical icu. i only had to carry a load of 8 patients (one time), and i was livid about it! i think the floor is totally 'assembly line' nursing. the units are very stressful, but i would i rather have ONE crashing patient with alot of good nurses around to give me a hand, than alot patients and just a few nurses around. ive noticed that generally the patients in surgical icu are easier than medical icu. anyone can learn vents, drips, monitors or whatever comes up, and if you dont know it, theres always someone there in the unit that does. i could never go back to working the floor now, i totally have to be able to see my patients from where ever im standing, i feel like i know more about my patient and i have better communication with doctors and family than i ever did working on the floor. its a different kind of stress, sometimes the worst part about it, is convincing yourself that you did everything you could do for a patient but they still died. go to surgical icu if you can, theyre so much easier, everything eventually ends up being protocol, cabgs, aaa's, carotid endarts... you never know what you'll get in the medical icu...gi bleeds, drug overdoses, and all the dirty patients with cdiff, mrsa, tb, they wont put those in the s-icu! good luck!

RNperdiem, RN · Apr 6, 2009

A nurse can minimize 3 areas of stress in ICU.

The ICU gives you more control over visitors(especially at night).

The doctors call back quicker.

There is less RN v/s CNA interpersonal conflict because we are not as dependent on them(if they even exist in the unit you work in).

Teresag_CNS · Apr 6, 2009

i need some feedback regarding the stress levels of icu as compared to a med/surge floor? likes and dislikes?
i'm getting burned out already in med/surge after only 9 mos the 8-9 pt assignments from 7p-7a are starting to wear on this noob rn. i know in my heart that i'm no where near ready to move into the unit with my limited knowledge, however, that time will come eventually.

i don't think the problem is that you are working med-surg - the problem is that you have 8-9 patients at a time! unless they are unusually low acuity, this is an unreasonable assignment. find a different employer, and ask questions like: how many patients will i have at a time? what are typical assignments like on this unit? can i speak to the rns on this unit (without administration in the room)? if you have to stay, share the research by linda aiken and others that demonstrates people die when nurses' assignments are unreasonable with your administrators. don't give up - 8 or 9 patients is not safe. protect yourself, your employer, and most of all, the patients.