Telemetry to ICU.... To stay or not....

[Katelyngrace]

Hear me out and give me your opinion (or support, which I need!!!)

I am weighing the pros and cons of leaving telemetry for ICU......

I have been working on a 33 bed telemetry unit for a little more than a year. It is a relatively small hospital, (ICU,Tele,MedSurg,OR,ER,L&D,Rehab, & CathLab). Recently I became the charge nurse of my night shift crew. I have found that I am starting to get worn down. The other night I started off with 3 patients and got 3 admits only three hours into the evening. I called my unit director and the supervisor begging for some help, and the only response I got was, "Look at the matrix and see what it says." I have gotten to the point to where I feel like asking for help is a waste of time, because I ought to just start on whatever I have to do and cross my fingers that none of my other patients go bad on me while I have to neglect them.

The whole point of this is to give you a picture of what I am dealing with. I love my job. I love what I do. I love *most* of the people I work with, (we have a few 'supernurses'). But am I justified in feeling that putting a 1 year old nurse in charge then sticking her with 6 very sick patients (sometimes 7!) is wrong? Or am I not cut out for this?

Sure, a bad night is a bad night. But this is consistent, and I feel like I am at my breaking point.

So, I finally broke down and applied for ICU in another hospital. There are two big differences that I think will help me not be so worn down.

The first (and biggest) is that this new hospital is a 3 day work week. The facility I am at now alternates 36 hour weeks and 48 hour weeks. I work every other weekend. The reason this wears me down so much is in part the sheer # of hours I work. (Keep in mind they always call you on your days off to get you to work and sometimes I am guilt tripped into coming in more.) My husband is a fireman:), which means with our schedules we sometimes will not see each other for a week. (And I love him so this makes me really depressed:cry:.) I miss out on a LOT of family time and I can't even have children right now because the insurance at the current hospital is awful, and I wouldn't have time to ever take care of my own kids!!

The second reason is because I think I will love ICU. I love analyzing and knowing everything about my patient. And it drives me crazy when I can't see my patient because I am too busy doing charting on 6 patients or dealing with tons of admits. Being able to FOCUS on every only 3 patients would be a dream for me. Don't get me wrong, I don't think ICU will be easier that tele, but I think it is where I am meant to be.

My manager loves me and told me 1 week out of orientation that I was already advanced to the proficiency of a 1 year old nurse. (Which was probably flattery to con me into being charge nurse ) I'm smart and have done well with learning on the job. However I do know my limitations, and I am not afraid to look dumb by asking questions. All I really want to do is take care of people. And I feel like I can't get through to people when I am in and out of their rooms, juggling meds/vitals/orders/tasks/admits/etc.

So if anyone takes the time to read this, (and bless you if you do). Am I digging myself into a deeper hole by attempting to crossover to ICU?

[jennycRN]

Go for it :-)

You mentioned weighing the pros and cons of leaving tele, but it doesn't sound like you have much reason to stay. If your manager thinks highly of you, hopefully she will be supportive of your professional growth and give you a great reference for the ICU job.

Best of luck to you!

[Katelyngrace]

Thanks! After writing it I kind of thought to myself, gee this sounds like a no-brainer after seeing all my issues written down. I guess I am reluctant because I love the people I work with, and I don't want to do anyone wrong by leaving.

[Sun0408, ASN, RN]

I left the floor and went to the ICU; I never left once I got there. I love it. Our ICU ratios are 2:1 though, really bad,crashing pts are often made 1:1 if the primary nurse can't walk away from the bedside. I say go for it !!!

[youngmalenurse]

Yeah you should probably leave. I work ICU and love it! Definitely has adjustments but so much better to have two patients that you know everything about versus 6 or 7 that you hardly know.

[eatmysoxRN, ASN, RN]

I'd switch. The ratios in tele are killing me. I'm considering moving too.

[CountyRat]

"the only response I got was, "Look at the matrix and see what it says.'"

Ah yes; reminds me of why I loved patient care so much, and hated hospitals so much.

"am I not cut out for this?"

No, the way that you feel does not mean that you are not cut out for high acuity nursing or for a position of leadership. I remember my first year in ICU. It seemed like a long time. I thought that a “veteran” like me should be doing better than I was. In fact, that first year is not a long time. You are still growing and learning, probably more than you realize. The reason that you feel overwhelmed is because you work in a very demanding area. There is nothing wrong with you, you are not a bad nurse, and you do not need to hesitate to follow the career path that draws you.

However, I think that is secondary to your relationship with your husband. If your work is coming between you and the one that you love, it is time for a change. I am a shriveled-up old codger of a nurse. I am very proud of the work that I have done. However, I have learned that nothing on this earth matters more than my wife and children, and the love that we share. Do what you need to do to draw closer to your husband and the rest will become clear to you in due time.

First things first, girl.

[turnforthenurse, MSN, NP]

I also say go for it.

I worked on a tele unit and the ratios and overall flow of the unit were beginning to kill me. I was there for nearly 2 years. Instead of going to ICU, I made a switch to the ER and I couldn't be happier.

[ppfd, BSN, EMT-P]

I'd do it in a second.

I give all the respect in the world to floor nursing. No way I could do it.

ED, any of the critical care units for me.

[multi10]

My advice: Go to the ICU. It's a whole new world where you, as a nurse, get to know and manage your 2 patients and all of their systems (cardiac, pulmonary, renal, etc.).

You will save lives in a first-person way. The doctors will respect you and count on you, as you'll respect and count on them. Respiratory, Lab, all are devoted and coordinated to save your patients. Your fellow nurses will do anything to help you.

That's the culture.

[Katelyngrace]

Thanks for the advice. :) It's a big change and a lot like 'starting from scratch', but I think it will be more than worth it.

[SENSUALBLISSINFL, BSN, RN]

The replies to the OP are so right on. CountyRat made a very good point, it appears that your current position is coming between your relationship with your husband, a person can only be patient so long. At the end of the day, family is what matters most. If the trend continues where nurses are so overwhelmed, they will continue to leave floor nursing, even new nurses will eventually burn out.

Best wishes on your decision.