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?

[qaqueen]

Dear OP,

Thank you for saying the things I have been thinking. Fortunately for me, I am not a charge nurse, but I am currently on tele and it is horrid!

When one pt starts to crump, I feel like I am neglecting the other 4. My shift managers are very busy (doing something) and rarely have time to lend a hand when things get crazy. However, they always have time to complain if you clock out 30 minutes late.

I have only been on this unit for 10 months and I have been sad, disgusted, and depressed almost from the beginning. My goal was to get to this hospital in the ICU. I took the tele position as a learning opportunity as I have only been a nurse for 5 years and I wanted to feel like I had an adequate background to move to ICU. I have excellent critical thinking skills and I enjoy higher acuity patients (as long as I have time to take care of them). I look forward to learning new skills and techniques, and I would love to be a truly holistic nurse that knows her patients.

So yes. I say, go for it!!!! I will be right behind you.

[VANurse2010]

You should see the ICU I just transferred to. It's one of, if not *the* most toxic, nastiest group of people I've ever worked with. I'm this close to going back to the floor.

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.

[multi10]

VANurse2010, I'm sorry to learn that you are working among a toxic nasty group of people in the ICU.

Are you able to care for your patients?

Are you learning every day/are you excited to learn?

Not all of your colleagues are toxic and nasty. Do you have at least one person at work you can talk to?

If you can answer "yes", then you can, and will, become a great ICU nurse.

It's like bootcamp and you just transferred there. Things will get better.

[soreadyRN, BSN, RN]

How long do you think you must be on the tele floor before you are able to switch to the ICU. I'm on a tele floor of a trauma one, do you think it would be possible to switch to ICU for smaller hospital?

[VANurse2010]

VANurse2010, I'm sorry to learn that you are working among a toxic nasty group of people in the ICU.

Are you able to care for your patients?

Are you learning every day/are you excited to learn?

Not all of your colleagues are toxic and nasty. Do you have at least one person at work you can talk to?

If you can answer "yes", then you can, and will, become a great ICU nurse.

It's like bootcamp and you just transferred there. Things will get better.

I went back to the floor in July. I didn't really care for ICU nursing, but I would have stayed if not for the people who work there. I was warned how they are before I went... c'est la vie. It's not failure if you're set up to fail - I mean that. I did telemetry for a year before I went over there - that was enough of a foundation.

[lisajtrn]

I went back to the floor in July. I didn't really care for ICU nursing, but I would have stayed if not for the people who work there. I was warned how they are before I went... c'est la vie. It's not failure if you're set up to fail - I mean that. I did telemetry for a year before I went over there - that was enough of a foundation.

I transferred to ICU after 10 years as an RN on the floor and was an RPN for 3 years before that on the same floor. This is my second career. I am most likely going back to the floor as soon as an opening becomes available. The "princess" mentality and "we are better than all other nurses" is far more than I can stomach.

[VANurse2010]

My boss was an experienced ICU nurse (we got along fine) - she said all ICUs have ego and personality quirks but that it was particularly toxic and extreme in the small hospital where I work (8 beds with a 4 bed step-down). I'm just the latest in a long line of RNs they've run off - including some people who are now in administrative roles and no longer work the floor at all. I didn't have a problem with the technical aspects of it, in other words I was not "slow to catch on" but while I was never in my boss's office on the floor over employee relations in over a year (and I haven't been since I've been back for over 2 months) I was talking the the ICU boss about nastiness on the ICU almost every other day. Life's too short. Not worth it!

[lisajtrn]

I know all about the ego quirks. I get along with everyone just fine and I can do my job perfectly well. I just can't tolerate the way some behave and the attitude they have towards nurses in other areas. There are some that don't feel superior to others but the ones that do just ruin the atmosphere for everyone else.