What happened to ICU while I was gone?

Nurses General Nursing

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Specializes in ICU.

Hi, all! I’ve been a nurse almost 20 years, ICU for majority of it, then took a 7 year hiatus which I hated in LTAC and telemetry so I thought I’d go back to the ICU that I loved- this is in a different state than before. 
 

the charting is absolutely unreasonable in my opinion. We use Epic system and they want hourly pain assessment, hourly oral care, four eyes on the patient every shift to document wounds, complete wound documentation every four hours (no copying), insulin witnessing, hourly I&O, head to toe every four hours, restraint documentation including education to both patient and family every two hours, then there’s the usual slaving over the vitals q15 and synchronized pumps, daily CHG bath documentation, and thanks to covid a simple IV tubing change means two sets of extensions, a label, and green caps on all ports, then there’s donning a gown, N95, shield for all patients that are intubated no matter what, ( this is probably common now), documenting RASS every hour while weaning sedation (I get that) the documentation on a post heart cath with a closure device in place was at least four solid hours of q15 vs and documentation… I know I’m forgetting stuff. Then there’s also an end of shift note, more education, and care plans… I did NOT have to deal with so much crap the last time I was in ICU and actually remember the old days of a trifold paper with check marks. I’ve only been at this new job one month and only get my one 30 min lunch which I can’t go to the cafeteria because it takes too long and don’t get any other breaks and barely a bathroom break during a shift . I can certainly see why everyone is leaving this job in droves. Contract nurses get bussed in morning and night to fill the gaps. I’m a full timer and starting to feel regret despite a $10,000 sign on bonus available first 30 days. Is this really the norm? Also they are getting three patients sometimes, taking fresh hearts with an additional patient… makes me want to just run away. I’m so disappointed.

3 Votes
Specializes in Critical Care.

I've been a nurse for 7 years and started in the ICU as a new grad. have done a couple of things too... this def seems to be the growing trend in the ICU and in an number of other specialties. If you didn't document it, it didn't happen... and therefore...you MUST document EVERY. SINGLE. THING.  It's not uncommon to spend more time documenting on the patients than the time you actually spend CARING for them.

I experienced a lot of what you stated above... often was interrupted during lunch because my "coverage" couldn't cover me anymore (or they just didn't want to). Cafeteria was too far, the lines were too long.. half my break would get wasted on just getting my food so I just stopped that and always packed my lunch... Packed it with many waters and quick grab and go snacks just in case I didn't get to actually take a full break... Will never forget how pissed I was at this "Alfa" charge RN who knew how to charm the right people and get her way - she was set on crawling up that latter. She got to a point where she was able to call more shots and take advantage of the rest of us. Big ego. We were her little minions.

Didn't get a break? Too bad - you must ALWAYS (at the end of the shift) select "yes" when the punch in/punch out clock asks you if you got your break. If you said no, she'd somehow find out... and have a discussion with you about it. It would go something like: "It makes the unit look bad when you say you didn't get your break - if you need help you KNOW you can always ask for it; maybe you should look at how YOU can do things differently and be better at asking for help and communicating what it is that you need."

What I need my effing break. 30 mins of uninterrupted time while working a 12 sometimes 14+ hour shift... just 30 mins and I'll actually be more effective at my job. I am human for Christ sake. 

A bit of a rant here for sure.. it is frustrating and this whole "just be positive and accept that you can't change XYZ and if you hate it just leave" mentality is BS and it isn't going to make a difference. It's just going to make things worse. 

I don't believe ALL ICUs (and other units / health care facilities) are like this... I do think that nursing in general is just getting pretty rough. Maybe it's been worse in the past for some of ya'll more experienced nurses... I'm no baby nurse but I am also no expert.

IDK. My two cents and late night thoughts on the matter. 

4 Votes

Sound about right. My hospital just got audited by Joint Commission, so yes, this is what they want for charting now. Every move you make needs justification. 

Give yourself time to adapt and build stamina.

I have been in nursing 25+ years and I do remember the trifold paper chart that you could fill out in less than 5 minutes. 

Specializes in Cardiac ICU.

I feel your pain! It has become incredibly tedious, time consuming and complex for documenting in EPIC, in addition to increased labor workload of more than 2 patients per nurse (Illinois just keeps shelving the Safe Staffing Act).  The bigwig CEO came around one Summer & informed associates that the reason why he received a $40M bonus (while we did not get any raise at all) was because "I run a multibillion dollar company!" Argh! WE are the ones that "run" the hospital. After all, without us - where would healthcare be? My hospital now has a web-based cloud and everything we do takes 5 minutes to access and insists we take our 30-minute lunch with a clock-in and clock-out "uninterrupted" lunch - that really brings it down to a 20 minute lunch (d/t lengthy time to log in and out at the beginning and end of our lunch). That is, when the cloud system is working! I don't mind working hard. What I do mind is being taken advantage of, squeezing as much as Administration can squeeze out of us! I like to say that if everything (other staff, equipment, etc) would work/perform like they should, we could be very efficient nurses! Most of the time, through, I can do their job - but they cannot do mine!

Ah yes, one year later, a lot of us have had huge turnover in the units. Nurses moved on to non-bedside jobs, NP jobs or went to become travel nurses. 

Where I work, that is most of the ICU, stepdown and (especially) floor. It was a great year to be a new grad because new grads got to work anywhere because of lack of staff. On the downside, the units are seriously lacking experienced staff on many shifts.

1 Votes
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
7 hours ago, RNperdiem said:

It was a great year to be a new grad because new grads got to work anywhere because of lack of staff.

It may have been great in a way to be a new grad, but in a way I feel so badly for the people coming into the profession with no support around them. I know that the majority of the unit where I work per diem is nurses with less than a year of experience or travelers. I think that right now there are five total regular staff members with more than two years in the unit. We have five new grads and five travelers. We have travelers orienting! Fortunately this current batch of travelers is good, but you never know. And with traveler salaries going down, from what I hear, are we still going to get good ones when these contracts expire? So who do these new nurses have to rely on for support and further education? And so many of the basics are being missed in the orientations, it's the first time in my career that if I knew someone that needed critical care I would tell them to drive right past our hospital. It's sad. 

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