Would You Rather: ICU or Floor?

[dontbetachy90, BSN, RN]

Hi, all! I have been working in a 24 bed step-down cardiac unit for the past 4 years on night shift, 4:1 patient ratio, and I am finding myself dreading work more often than not. I was looking to get some advice from nurses who have transitioned from the floor to ICU positions, or even vice-versa... or anyone who has experience in various areas of acuity!

I understand ICU nurses bear greater burdens due to how critically ill their patients, but I am wondering if the "flow" is less chaotic than on the floor? Is there a huge difference between how busy day shift and night shift ICU is, similar to how day shift on the floor is ALWAYS chaotic due to admits/DCs/family/docs/testing?

Disclaimer: I don't mind being busy, but there is a certain "type" of busy I prefer and I have a feeling I may be better suited for ICU, and I am ready to switch to a day shift schedule soon.

Thank you for your input :)

Things I DO like about my shift/unit:

- Currently a clinical leader on my floor = higher pay (would sacrifice this if I change shifts/departments)

- Many of our patients are quite sick/high acuity. We manage a variety of anti-arrhythmic infusions/treatments, Remodulin for end-stage PAH, high-flow o2 and bipap, pre/post cath/PPM/AICD/CABG/TAVR patients, etc. I find that I rather enjoy these patients who are a bit more involved.

- Some of our pts are AOx4/ambulatory/overnight stays = easy-peasy

- The camaraderie! We've got a close-knit, hard-working team

- Night shift = no management = more autonomy = food at the station without fear of getting fired (I know that is a bogus "pro" but hey, it's true)

Things I DON'T like about my shift/unit:

- Lack of resources. Sure, no management is fun but now and again we need that backbone, especially with 80% of our staff being new-grad RNs on nights.

- Seldom fully staffed on nights

- My social life & health have taken a dump. Always exhausted.

- 4 patients = quadruple headache in terms of family demands, coordinating care between departments/services, balancing 3 other patients with simultaneous admissions/discharges.

- Discharges. Let me just leave it at that -- 6 consults who can't agree and one nurse who has exactly 2 hours to figure it out before Utilization Management flips their crap meanwhile another discharge/admission two doors down and 3 screaming family members and the CRF/discharge med-rec are STILL incomplete after calling admitting for the um-teenth time (This is the main reason I won't go to days on my unit - 3 discharges and 3 admissions in one shift? I'd rather give lactulose enemas for 12 straight hours.)

[nutella, MSN, RN]

IMO step down is the worst - even worse compared to telemetry floor because patients are high maintenance with often dysfunctional situations/ families etc but lack of resources ....

ICU is great - I haven't worked in critical care for some while but did in the past - loved it.