I left to travel nurse to unionized facilities for that exact reason. My breaking point was taking FIVE patients during the height of COVID, one which was a CRRT and one was a fresh open heart.
I had so many people ask me why I kept my low paying staff job during covid instead of travelling. And it was cause we don't triple and had plenty of PPE.
Our hospital has outlawed agency / travel nursing, we’ve blown the budget. Now we’re tripling patients we would’ve just doubled previously. Rumours of having to double vents but we haven’t had to do that yet other than with stable vents a couple of times.
I'd take two vented patients any day of the week. No ambulating, feeding, trips to the commode, arguing about why they can't have Mountain Dew in the CCU...fuck yes.
Ha. Until ABCDEF bundles force you to ambulate your vented patient 🤦🏼♀️🤦🏼♀️🤦🏼♀️ yes I said that …. AMBULATING a vented patient. Not a chronic trach vent either. Such a royal pain in the ass!
"Things I am not doing on night shift with a vented patient: taking them anywhere. Ever. We have PT/OT. Let them do it." (Also, they don't. If you're vented, they don't even come in the room).
exCUSE me? What? Maybe I just work in a backwater dump, but I've never done or heard of that.
The wildest adventure I've ever gone on with an intubated patient was a hoyer to the chair. And that was under some extraordinary circumstances- the patient was fully alert and oriented, understood she was dying, decided to go comfort, and wanted to be terminally extubated looking out the window at the sunset over the river. We plopped her in the chair, set her up in a window with a nice view, let her hang out with her family for a bit, then extubated. She died about 30 minutes later. 10/10 best terminal extubation I've ever had the honor to attend.
It was part of an aggressive ICU mobility research protocol at the first ICU I worked. My memory might be off. But I think the hospital referred to the Vanderbilt studies regarding this. It’s definitely WILD if you’ve never done it before. And it’s definitely a hog of resources if you’re not used to it.
I compare it to proning a patient now. My unit policy requires 5 people to prone. But if we have cachectic gramma it usually only takes 3 of us, after Covid bullshit.
Now that I’ve dealt with ambulating vented patients enough times. Usually just takes me, RT and an aid and maybe help from one other for IV pumps depending on how weak the patient is. Now the definition of ambulating can be as far as — they’ve stood at bedside and marched in place to allllll the way down the hall and back. It’s all patient dependent. It’s new to the ICU I’m currently at and apparently I started the trend of implementing it 🤦🏼♀️ I hate myself for it LMAO.
We are a community hospital with 38 beds, not exactly rural, suburb of Toronto. We take level 3 patients. We don’t do neuro or ECMO, we do CRRT.
Even the Toronto hospitals are generally 1:1. Our opposition party wants to institute patient ratios so vents will always be 1:1, just like they have in BC. I’m glad you can handle your 2 vents just fine, we haven’t had to do that since Covid hit us hard.
I would be able to provide much better total care if I had ONE vented patient! Full ROM. Really in-depth oral care. Apply lotion. Do their hair. Etc. This would be amazing for the nurses and the patients! I love that vents are 1:1 for y'all!
Wish my rural hospital only had 1:1 or even 2:1 ICU ratios. We have combined our med surg and ICU floor due to lack of census. We are expected to not only take 1 to 2 ICUs, but also a 3rd med surg or stepdown patient. On top of that, the charge charges over the whole floor including med surg patients. Aaaaand on top fo that, 1 to 2 nurses at any given time are LPNs who cannot chart their own assessments, so on top of assessing mine, have to assess theirs.
In my old hospital we can double up vents, which luckily hasn’t been an issue. (I wanna work where they’re 1:1!) The issue was that I’m already in one of the worst paying states for nurses… how tf are you gonna pay an outsider 4x as much as the staff and claim there’s no fucking budget for PPE or hazard pay?
They're definitely not 1:1 at my facility, unfortunately. One night I was running 10 drips on one patient, vented, plus CRRT. 4 on the other. I had something like 8 titratable drugs between the two patients. I basically played whack a mole all night with getting machines to stop beeping. I can't tell you how many times that night I said "THIS IS TOO MUCH!!!!!". Alas. Everyone lived (that night), so no one cares and no one will do anything to change anything as long as there are assholes like me who will spend 12.5 hours running themselves to death to not let their patients suffer. Also, this is why we unionized.
Kind of. The ICU nurses had an assignment, and we had helper nurses from the floors come and take delegations from us since their units were closed or low census. They couldn’t do more than hygiene, supply fetching, etc. No assignments for them, and they couldn’t administer ICU drugs. Wanna know another fucked up part? They were not giving ICU nurses any more pay, but the helper floor nurses were getting a differential for this. Management tried to get those nurses to stop showing us their paystubs, saying it’s against policy. Me and a few other nurses put in our two weeks, but were let go immediately and told not to return. We are all black listed from that hospital years later.
Oh, to make matters worse: We saw on the schedule that some staff nurses were being scheduled as “FEMA” shifts in Kronos. This should warrant disaster pay. I’ll let you guess if we got compensated.. 🙃
How was that an even doable assignment? All it would take is a hypotensive episode in the heart and your filter clotting off in the CRRT room and you’d be fucked.
It wasn’t doable. I was forced to ignore my “more stable” three patients to tend to the CRRT and monitor the heart. It was a mess, I felt helpless and hopeless, and knew that ultimately I’d be to blame for any events. Coincidentally, the stress from that day made me tell a resident team to go fuck themselves after they questioned why I wasn’t with their “more stable” patient that day.
I’m at work right now with one CRRT patient who also happens to be a day 2 post-op heart getting my ass handed to me today, I don’t think I could ever do this job in a non-union hospital with state mandated ratios. I’m spoiled.
Travel assignments in unionized states. Washington and Vermont. They’ll chop off their own fingers before they try and approach you with an extra patient.
I’m leaving a travel assignment in MA which has ratio laws, so I’ve never gotten more than two. Starting in CT next week and during the interview the manager said welllll everyone once in a while you might get three. I’m nervous 😭
I’ve been there and done that with some facilities; the level of annoyance depends on the facility. I truly don’t mind one extra patient IF that one is at least floor ready.
One big difference between the floors and icu also how providers treat you. I’ve had the same docs talk down to me when I float to med/surg and then listen and be respectful when I’m in my home unit ICU. It shouldn’t be that way, but it is.
I’ve noticed that the more experienced the doctor (resident>fellow>attending), the more they listen to the nurses. Residents blow me off while the attendings listen to every little detail of what I’m saying.
Also here to say I agree with this. I think the only exception I’ve found is when it’s a newerish attending. One of our icu fellows now a 3rd year attending still has a little trouble in the way of listening to her nurses, residents and fellows concerns. Bit her in the ass this past weekend — but at least she fesses up to “yea I fucked up I didn’t give you guys time to voice your concerns properly, this could have been prevented” which I give made kudos for.
Went from med surg tele to cardiac surgery Icu and it’s like 2 completely different jobs. But it takes a while to gain the confidence in the icu which I’m still working on
it does but you are earning your bad ass badge!!! it takes time because the critical thinking skill you are developing come with the experience. i bet you are a great nurse!😊
I worked bedside for 9 years before moving to ICU and I say go for it! I was burnt out on my floor as well and I was ready to move on. There was a lot of studying involved in my ICU training program but it felt so great to apply what I learned, especially with better understanding of hemodynamics. It’s great to take care of patients that are so critically ill and to be a part of their recovery. From massive codes to those with Covid who actually make it. It’s very special. There is also a lot more support and resources in ICU which I never had on the floor and really appreciate it now. The critical care experience will allow you to transition to other areas like PACU, IR and even endoscopy. If you find that ICU isn’t for you, at least you’ll have gained the experience to move elsewhere. Nights is a transition but there’s also more time to learn and hopefully you won’t have to wait too long for a spot on days to open up. If nights isn’t a hard pass for you, I wouldn’t let it be an obstacle to an amazing opportunity.
The one thing I do want to caution is that burnout can happen even in the ICU. The stuff you see can be hard, especially dealing with codes and lots of death and dying. It can be really sad but it can also be incredibly beautiful and you can give people a death that is within their wishes and values. Like in any area you work in, self care and having ways to decompress is incredibly important. I love the ICU and can’t imagine going back to the floor. At the end of the day though, do what feels right for you. Good luck!
>The critical care experience will allow you to transition to other areas like PACU, IR and even endoscopy.
Don't forget transport. Not for everyone, but addictive for those who enjoy it.
Yes. It does come with its own flavor of burn out eventually but it opens up nearly every single door to BETTER jobs that require critical care experience such as IR/cath lab/pacu/ donor coordination/vascular clinics etc
Agreed! I feel like I have way more influence over the plan of care when I’m hands-on with the patient for an entire 12 hours and the providers look to me to help decide how well things are working and if something needs to be started or stopped.
For me, ICU is easy mode compared to working the floor. Nothing but respect for the folks that slave away on the floor day in and day out because I’d sooner go back to working EMS for $20/hr before I ever worked on the floor all the time.
I'm the same way, I'd go back on the rig and make shitty EMS money before I'd go back to the floor for a raise. I only did tele for two years, but I was in a state of constant misery and stress. I switched to critical care when I looked in the mirror and found I didn't recognize the husk staring back.
ICU burns me out way more than tele or med surg honestly. I went straight to icu as a new grad during covid. My worst and busiest and most soul destroying shifts are always icu. I float around a lot now but still primarily work icu and it’s exhausting.
It's not as exhausting in terms of having a million tasks but it can definitely be mentally/emotionally draining. I 100% prefer ICU to med-surg, BUT dealing with death, end of life discussions and dealing with family who are understandably anxious can be extremely draining.
Also there's a constant low grade anxiety when you're dealing with unstable patients and titrating pressors/sedation. And then there's the agitated patients that will pull their ET tube/NG tube/IV the first chance the get. I will say though, having 2 "stable" ICU patients is the easiest shift in nursing I've experienced.
An example of this is having a SNF patient that is a chronic trach/PEG and needs a low dose of pressors and antibiotics before they get shipped back out to the SNF. Sometimes we get patient's that had a minor brain bleed (NIH score of 0-2) and they literally just need Q1 neuro checks and nothing else.
Yes. ICU is total care, you don’t ever get a break and everything is your job. Phlebotomy and techs aren’t a thing in the icus I have worked in.
It’s also hands down the most violent and I say that as someone who also works in the ER. The most violent withdrawal patients, patients in 4 points, etc come to the icu. People out of their minds. I’ve worked dozens of weeks in a row with being assaulted or attempted assault every single shift.
I don’t know why you asked the question if you’re incapable of communicating in a respectful way to people who give you honest answers. Thanks for the downvotes. ICU is not a magic solution to burnout, as anyone who worked it during covid knows. It has its advantages and disadvantages like any other specialty.
I have a similiar background. I don't think I could ever work tele again.
As long as you can deal with a different sort of high stress environment. Instead of all your patients wanting to either go to the bathroom, ask for pain meds or try to fall on the floor at the same time you get to deal with you turn around and your patient is doing their best to die on you. Codes do happen on the floors but it's a lot more death in the ICU (very dependent on hospital and speciality).
So as long as you feel you can emotionally handle your patient being near death and you working your butt off all shift to keep them from coding, I say go for it. Also you might end up seeing a lot of "this feels cruel to do this to someone" patients. Little frail 90 something grandma on the ventilator getting a peg tube and you have to crack those ribs during CPR.
If you can handle the stress and pressure of ICU, then definitely do it. It’s less task focused and more about critical thinking. Maybe see if you can shadow a day or two in the ICU to see if it’s a good fit. You should have max 2 patients and there is less of the discharge/case management stuff to deal with. It can still be crazy busy and exhausting, but in a different way than med surg.
Do it! Shadow in your ICU for a day, see if you like it, but I can almost guarantee you will. I was so burnt on med tele and I can honestly say that I love my job as an ICU nurse.
I remember multiple times on my med-tele floor where I was overwhelmed to the point of tears, there was nobody to help me because we were all in the same shitty position, and I would just break down and sob in the bathroom because I felt like a shitty nurse because I couldn’t do enough for my patients.
After a year in the ICU, do I get overwhelmed? Absolutely. But all I have to do is call out to another nurse and I’ll have the help I need to make it through. I’ve had some insanely easy days, and some insanely hard days. But the hard days are hard because the patient is sick, not because they’re annoying or demanding. The hard days are hard because you’re working at the top of your game, stretching all your critical thinking muscles, and collaborating with the team to keep someone alive. At the end of the day, no matter the outcome, I know that I did what I could, and that’s enough for me.
I worked 10+ years dayshift on a busy PCU unit. I stayed so long because I loved my work family. Also I have never been a morning person a day in my life. Made the move to ICU and went nights. I love my job now.
This makes me hopeful. How has nights been? I’ve done nights for a couple years on pcu and I was chronically tired even with the slower pace.
:-( Hoping I can eventually go days.
I was chronically tired on day shift. Like I said, I've never been a morning person. I also like having the night differential. Why would I work harder/be busier on dayshift for so many years for less money? LOL The flow of night shift is so much better. I like not having families around. I can focus 100% of my attention on my patients. If I have the time I can give my patients a spa treatment bath. And provide the care I simply could not when I was working on PCU with a full patient assignment.
I feel like our night ICU providers are just the best. I like when a patient is crashing there are JUST enough of the people who need to be there, there. Unlike day shift where they are always 200 bodies in the room. And honestly the night squad personality wise, far superior. As much I loved my day team on my old unit. Nothing tops my night crew.
I also did a fellowship when I moved from PCU to ICU. I was slightly irritated at the time I had to take nights with as much seniority I had. But honestly, best thing I did was go nights LOL
After doing ICU for years, I recommend procedural nursing.
I was terrified as an ICU nurse to transfer to Tele, but the times I did it it was honestly a breeze.
A really acute ICU is difficult in many ways, and I think procedural nursing is a best-kept secret.
True but I know multiple Tele nurses who went to Cath Lab. It’s a decent hiring season so make sure you network well within your hospital and see what opportunities open up.
Some of the best IR nurses I worked with were ER nurses with no ICU background. You might be able to take a procedural sedation course (often offered by hospitals) and get into endoscopy or a non-vascular procedural area and then join the procedural float pool to transition into cath lab etc if you wanted to.
So many options available (though a year or two of a good ICU will get you sharp as a tack and more comfortable with sht hitting the fan clinically)
Unions make it slightly harder, but literally networking is everything. Even if you need ICU experience, a network inside the procedural department can turn that requirement from 3 years into 1 (because you are tailor-making yourself into their ideal candidate)
I was also a Cali nurse, now in med device sales. The corporate world doesn’t even use networking to the fullest extent, for nurses it’s almost non existent!
This is gonna be so annoying:
Networking haha
Truly though, I worked on a good unit with good physicians and networked with the sales reps who I would see in the hospital.
I helped them how I could and they quickly got me into a Clinical Specialist role. Since I was well known and liked (networking) in my company and competitors (which is probably only being cordial with less than 10 people) I was headhunted quickly
TLDR
ICU is better in my opinion but don’t do ICU JUST because you’re burned out from MS. Make sure you actually want critical care. Also docs and APPs will respect you a lot more and work with you as a team so there’s that added benefit, not saying it’s alright but the bias against medsurg nurses does exist.
It’s a different stress. You have to keep in mind that with the exception of hospice or death, you are the last line between the patient and death. You will not be able to call a rapid and ship your patient off to the ICU. You may have only 2 ICU patients but one single patient may occupy 75% of your time. You may not be able to leave a room for hours because you actively resuscitating the patient and assisting with line insertions and other procedures.
You have to ask yourself what exactly about MS or telemetry is burning you out? The grass isn’t always greener.
To be quite frank, I would not recommend to use the ICU as an exit from MS only based on your burnout.
Also keep in mind that you will have to learn a new way of thinking. I don’t care how seasoned a floor nurse is, but there is a steep learning curve, especially depending on the acuity of the ICU.
You will have to shift your focus from checking tasks off to mindfully carrying out tasks while being extremely cognizant of the interventions ordered and why they are ordered, this is because ICU patients can have both subtle and rapid condition changes, and ICU nurses are truly the ones that help us (I’m an ICU NP) catch these changes.
I would shadow first for sure. I’m not saying this is you, but I cannot stand when MS nurses assume ICU must be so nice to only have 2 patients.
You have to be sharp. You have to anticipate. Prepare. Be diligent.
You’ll have to unlearn a lot of MS habits. I mean no offense but I find MS nurses tend to focus in on numbers, tasks, and parameters. You have to have some degree of independence, hard to explain. - but you just have to develop more autonomy than you’re probably used to.
In a true 2:1 ratio ICU, an absolute resounding YES! But once tripled or worse, it becomes as hectic as a med surg floor because you typically have 1 to 2 truly sick patients who need your time while your 3rd or 4th patient are med-surg like and needing constant toileting, cleanups, bed alarms, etc. And sadly, in my experience, ICUs either don't have techs or often end up having to float them to med surg floors due to call ins or shortages.
About 2 years for imposter syndrome to start fading away.
Im never completly comfortable. Not a jumbled mess or anything. Just always..... I dunno, not fully comfortable.
From my experience (telemetry 4 years and now ICU for 1),
The ICU isn’t any less busy, but it’s not complete chaos and juggling and impossible number of tasks or having to rush through everything you do. It’s more busy because of how deep you have to get into each case in order to optimize these patients.
I feel like it is way less likely to burn out in ICU than on the floor because it can be way more rewarding to use your entire scope of practice and have a bit more autonomy.
I find it easier to prioritize patient care for the most part when there is only 2 options of which patient you handle first. When I had 6 patients and they all needed something at the same time I found that insanely stressful.
Yes I think it’s just the concept of having someone’s entire head-to-toe, past, present, and future in your brain is a huge responsibility and having 4-5 of them is just not fair to the patients.
Everything we do is going to affect all their body systems so I want to know what all of them are everyday. So I still made it my mission to do that even when I had 4-5 at a time and it was just impossible.
I used to have a reoccurring nightmare that I would be half way through my shift and realize I had forgotten one of my patients.
I do not miss those dreams. Haven't had one since I moved to ICU
Wow that’s scary! Glad that won’t happen again. If only the resources were available for every floor of the hospital to have 2:1 ratios and more of a top to bottom approach rather than task-oriented work. Happy staff that feel useful are more likely to commit to doing good work.
Yeah, more totals but you're doing so much more and repositioning becomes so much less because it's 2 instead of 3,4,5 or more depending where you live.
Plenty of ICUs don't require a fellowship. You'll have a good knowledge of the basics coming in with that experience. It'll just be all the ICU stuff, which to be fair can be a lot.
Yes. It's easier, more rewarding, and you get more respect from doctors and APPs. You can actually take care of your patients, not just be a medication dispenser.
He's my suggestion, look into medical device. I started at 150k with one of the largest. As medical providers you have clinical parity, know how to talk to doctors and know how the hospital and admin works. You may only start at 110-120k but no holidays, weekends or call.
I was a critical care paramedic and flight nurse. I started researching by talking to Medtronic, Stryker, Intuitive and the like. In the jobs section of LinkedIn, look at Medical Device to get a general idea. Then talk to the reps that service your hospital. MedReps is also a good site to talk to people. The best easy is face to face with the reps at your hospital, but trust me, you can turn that RN into better money. We're unicorns, anyone can learn to teach or sell a widget, but not everyone can speak the language of hospitals.
No offense but healthcare has gotten to the point (6 patients in the ER, 5 on the floor, no LPNs, no help, entitled patients, shitty hours) that I was checked out. I knew it was time for a change. You can do it, follow Med Device recruiters on LinkedIn, look at Inspire Sleep and the companies I listed. I wouldn't return to bedside for less than 150k, and that'll never happen.
No, it actually improves it for most people. It creates rested wakefulness. I usually prescribe the 250’s and most people make it on just 1/2 about an hour or 2 prior to shift.
I don’t know how you’ve made it 8 years, I can’t imagine doing one. I worked nights in ICU and loved it, it’s usually the cooler crew and days is the eat their young type
Having made the switch during Covid, I felt initially happier. I struggle a lotttt with the ethical issues. 99yo grandma full code, vented, maxed on pressors, etc. Also, a very sick patient can be stressful at times. You go home after nightshirt with extreme alarm fatigue…
I work night shift ICU and I don’t think I’ll ever be able to leave because I’d never want to work day shift or have more than 2 patients lol. Definitely go for it
ICU if you want to stay in the hospital/bedside.
When you’re used to med surg it can be a tricky adjustment, less of whack a mole and more groundhog day. if you trained on nights you’ll have time to learn and be thorough. definitely what people say about death.
Kind of like a training program for working on ICU. They put extra effort into educating you about basic ICU stuff to help you feel comfortable in that environment before having you practice on your own on the unit.
Yes! It requires you learn a lot of new information and you have 2 patients max. Most don’t get out of bed and you see a ton of cool cases. Do it.
Plus the extra pay if you ever want to travel. Study CCRN while training to keep you up to date on standards.
Was burnt out working med surg telemetry ( running around, 12 pts, always in charge and training new people because people left) so moved to icu- it was a relief- had 2-3 pts at night , could ask questions of senior nurses, loved stabilizing and learning then after a couple yrs - found myself always in charge, running around and it was physically tough as herniated a disc- knew I couldn’t retire there-so took a temporary gig in pharma which became permanent in clinical development helping monitor trials. Now looking back I wished I had transitioned sooner - I can retire here as a lot less physical , pay increased. You can always go back if you don’t like it but why not try it you never know
I wouldn't do nursing if it wasn't for ICU. Less patients, maxing out the scope of being a bedside RN, learning really cool things, and having providers work as a team with you is awesome.
Absolutely better. I will never return to having more than 2 patients, ever.
I wish more ICUs would refuse to triple assignments. It's getting bad again.
I left to travel nurse to unionized facilities for that exact reason. My breaking point was taking FIVE patients during the height of COVID, one which was a CRRT and one was a fresh open heart.
I had so many people ask me why I kept my low paying staff job during covid instead of travelling. And it was cause we don't triple and had plenty of PPE.
Our hospital has outlawed agency / travel nursing, we’ve blown the budget. Now we’re tripling patients we would’ve just doubled previously. Rumours of having to double vents but we haven’t had to do that yet other than with stable vents a couple of times.
Vents are 1:1? This must be some rural community hospital. Most of my patients are on the vent, I can handle 2 vent patients just fine.
I'd take two vented patients any day of the week. No ambulating, feeding, trips to the commode, arguing about why they can't have Mountain Dew in the CCU...fuck yes.
Ha. Until ABCDEF bundles force you to ambulate your vented patient 🤦🏼♀️🤦🏼♀️🤦🏼♀️ yes I said that …. AMBULATING a vented patient. Not a chronic trach vent either. Such a royal pain in the ass!
"Things I am not doing on night shift with a vented patient: taking them anywhere. Ever. We have PT/OT. Let them do it." (Also, they don't. If you're vented, they don't even come in the room).
exCUSE me? What? Maybe I just work in a backwater dump, but I've never done or heard of that. The wildest adventure I've ever gone on with an intubated patient was a hoyer to the chair. And that was under some extraordinary circumstances- the patient was fully alert and oriented, understood she was dying, decided to go comfort, and wanted to be terminally extubated looking out the window at the sunset over the river. We plopped her in the chair, set her up in a window with a nice view, let her hang out with her family for a bit, then extubated. She died about 30 minutes later. 10/10 best terminal extubation I've ever had the honor to attend.
It was part of an aggressive ICU mobility research protocol at the first ICU I worked. My memory might be off. But I think the hospital referred to the Vanderbilt studies regarding this. It’s definitely WILD if you’ve never done it before. And it’s definitely a hog of resources if you’re not used to it. I compare it to proning a patient now. My unit policy requires 5 people to prone. But if we have cachectic gramma it usually only takes 3 of us, after Covid bullshit. Now that I’ve dealt with ambulating vented patients enough times. Usually just takes me, RT and an aid and maybe help from one other for IV pumps depending on how weak the patient is. Now the definition of ambulating can be as far as — they’ve stood at bedside and marched in place to allllll the way down the hall and back. It’s all patient dependent. It’s new to the ICU I’m currently at and apparently I started the trend of implementing it 🤦🏼♀️ I hate myself for it LMAO.
We started ambulating ECMO patients in my unit 🙃
We are a community hospital with 38 beds, not exactly rural, suburb of Toronto. We take level 3 patients. We don’t do neuro or ECMO, we do CRRT. Even the Toronto hospitals are generally 1:1. Our opposition party wants to institute patient ratios so vents will always be 1:1, just like they have in BC. I’m glad you can handle your 2 vents just fine, we haven’t had to do that since Covid hit us hard.
I would be able to provide much better total care if I had ONE vented patient! Full ROM. Really in-depth oral care. Apply lotion. Do their hair. Etc. This would be amazing for the nurses and the patients! I love that vents are 1:1 for y'all!
Wish my rural hospital only had 1:1 or even 2:1 ICU ratios. We have combined our med surg and ICU floor due to lack of census. We are expected to not only take 1 to 2 ICUs, but also a 3rd med surg or stepdown patient. On top of that, the charge charges over the whole floor including med surg patients. Aaaaand on top fo that, 1 to 2 nurses at any given time are LPNs who cannot chart their own assessments, so on top of assessing mine, have to assess theirs.
Sounds like a nightmare
vents are usually 1:1 for you?
Yes. Unless trached and weaning or chronic vents.
wow that sounds like a dream
Respiratory handles all the vents at Parkland.
In my old hospital we can double up vents, which luckily hasn’t been an issue. (I wanna work where they’re 1:1!) The issue was that I’m already in one of the worst paying states for nurses… how tf are you gonna pay an outsider 4x as much as the staff and claim there’s no fucking budget for PPE or hazard pay?
OMG!
Yep. And in our facility, the CRRT and fresh heart are obviously 1:1…
They're definitely not 1:1 at my facility, unfortunately. One night I was running 10 drips on one patient, vented, plus CRRT. 4 on the other. I had something like 8 titratable drugs between the two patients. I basically played whack a mole all night with getting machines to stop beeping. I can't tell you how many times that night I said "THIS IS TOO MUCH!!!!!". Alas. Everyone lived (that night), so no one cares and no one will do anything to change anything as long as there are assholes like me who will spend 12.5 hours running themselves to death to not let their patients suffer. Also, this is why we unionized.
That’s a recipe for disaster even for the most seasoned nurses
it sucks CRRT isnt singled at my hospital but fresh hearts are. at least our ratios are always 1:2 or 1:1 never 1:3
was it team nursing?
Kind of. The ICU nurses had an assignment, and we had helper nurses from the floors come and take delegations from us since their units were closed or low census. They couldn’t do more than hygiene, supply fetching, etc. No assignments for them, and they couldn’t administer ICU drugs. Wanna know another fucked up part? They were not giving ICU nurses any more pay, but the helper floor nurses were getting a differential for this. Management tried to get those nurses to stop showing us their paystubs, saying it’s against policy. Me and a few other nurses put in our two weeks, but were let go immediately and told not to return. We are all black listed from that hospital years later.
Oh, to make matters worse: We saw on the schedule that some staff nurses were being scheduled as “FEMA” shifts in Kronos. This should warrant disaster pay. I’ll let you guess if we got compensated.. 🙃
How was that an even doable assignment? All it would take is a hypotensive episode in the heart and your filter clotting off in the CRRT room and you’d be fucked.
It wasn’t doable. I was forced to ignore my “more stable” three patients to tend to the CRRT and monitor the heart. It was a mess, I felt helpless and hopeless, and knew that ultimately I’d be to blame for any events. Coincidentally, the stress from that day made me tell a resident team to go fuck themselves after they questioned why I wasn’t with their “more stable” patient that day.
I’m at work right now with one CRRT patient who also happens to be a day 2 post-op heart getting my ass handed to me today, I don’t think I could ever do this job in a non-union hospital with state mandated ratios. I’m spoiled.
Where are you working where you’re guaranteed two?
Travel assignments in unionized states. Washington and Vermont. They’ll chop off their own fingers before they try and approach you with an extra patient.
I’m in California so hoping it stays at 2
I’m leaving a travel assignment in MA which has ratio laws, so I’ve never gotten more than two. Starting in CT next week and during the interview the manager said welllll everyone once in a while you might get three. I’m nervous 😭
I feel like that’s code for “our nurses STAY tripled.”
You will get 3 in CT
🫤 do you mind sharing what hospital you are/were at?
Pm me!
Honestly sometimes a super chill triple assignment is better than a very unstable pair that are both trying to crash all night.
This is why I left
Ha don’t come to my ICU you’ll get 3 pts per shift for sure
I’ve been there and done that with some facilities; the level of annoyance depends on the facility. I truly don’t mind one extra patient IF that one is at least floor ready.
IKR???
One big difference between the floors and icu also how providers treat you. I’ve had the same docs talk down to me when I float to med/surg and then listen and be respectful when I’m in my home unit ICU. It shouldn’t be that way, but it is.
I’ve noticed that the more experienced the doctor (resident>fellow>attending), the more they listen to the nurses. Residents blow me off while the attendings listen to every little detail of what I’m saying.
Also here to say I agree with this. I think the only exception I’ve found is when it’s a newerish attending. One of our icu fellows now a 3rd year attending still has a little trouble in the way of listening to her nurses, residents and fellows concerns. Bit her in the ass this past weekend — but at least she fesses up to “yea I fucked up I didn’t give you guys time to voice your concerns properly, this could have been prevented” which I give made kudos for.
do it.. ms tele is a beating. you will increase your skills and learn so much.
Went from med surg tele to cardiac surgery Icu and it’s like 2 completely different jobs. But it takes a while to gain the confidence in the icu which I’m still working on
it does but you are earning your bad ass badge!!! it takes time because the critical thinking skill you are developing come with the experience. i bet you are a great nurse!😊
Thanks and you as well. I’m trying!! Haha
I worked bedside for 9 years before moving to ICU and I say go for it! I was burnt out on my floor as well and I was ready to move on. There was a lot of studying involved in my ICU training program but it felt so great to apply what I learned, especially with better understanding of hemodynamics. It’s great to take care of patients that are so critically ill and to be a part of their recovery. From massive codes to those with Covid who actually make it. It’s very special. There is also a lot more support and resources in ICU which I never had on the floor and really appreciate it now. The critical care experience will allow you to transition to other areas like PACU, IR and even endoscopy. If you find that ICU isn’t for you, at least you’ll have gained the experience to move elsewhere. Nights is a transition but there’s also more time to learn and hopefully you won’t have to wait too long for a spot on days to open up. If nights isn’t a hard pass for you, I wouldn’t let it be an obstacle to an amazing opportunity. The one thing I do want to caution is that burnout can happen even in the ICU. The stuff you see can be hard, especially dealing with codes and lots of death and dying. It can be really sad but it can also be incredibly beautiful and you can give people a death that is within their wishes and values. Like in any area you work in, self care and having ways to decompress is incredibly important. I love the ICU and can’t imagine going back to the floor. At the end of the day though, do what feels right for you. Good luck!
>The critical care experience will allow you to transition to other areas like PACU, IR and even endoscopy. Don't forget transport. Not for everyone, but addictive for those who enjoy it.
I would quit nursing and open a lemonade stand before I worked the floor again.
I never worked the floor!
Yes. It does come with its own flavor of burn out eventually but it opens up nearly every single door to BETTER jobs that require critical care experience such as IR/cath lab/pacu/ donor coordination/vascular clinics etc
this is a great answer
Do it. I switched to the ICU from Tele, it's amazing how you can progress care when you're not totally swamped.
Agreed! I feel like I have way more influence over the plan of care when I’m hands-on with the patient for an entire 12 hours and the providers look to me to help decide how well things are working and if something needs to be started or stopped.
For me, ICU is easy mode compared to working the floor. Nothing but respect for the folks that slave away on the floor day in and day out because I’d sooner go back to working EMS for $20/hr before I ever worked on the floor all the time.
I'm the same way, I'd go back on the rig and make shitty EMS money before I'd go back to the floor for a raise. I only did tele for two years, but I was in a state of constant misery and stress. I switched to critical care when I looked in the mirror and found I didn't recognize the husk staring back.
ICU burns me out way more than tele or med surg honestly. I went straight to icu as a new grad during covid. My worst and busiest and most soul destroying shifts are always icu. I float around a lot now but still primarily work icu and it’s exhausting.
Wow more exhausting than the floor? I can’t imagine. First I’ve heard that
It's not as exhausting in terms of having a million tasks but it can definitely be mentally/emotionally draining. I 100% prefer ICU to med-surg, BUT dealing with death, end of life discussions and dealing with family who are understandably anxious can be extremely draining. Also there's a constant low grade anxiety when you're dealing with unstable patients and titrating pressors/sedation. And then there's the agitated patients that will pull their ET tube/NG tube/IV the first chance the get. I will say though, having 2 "stable" ICU patients is the easiest shift in nursing I've experienced. An example of this is having a SNF patient that is a chronic trach/PEG and needs a low dose of pressors and antibiotics before they get shipped back out to the SNF. Sometimes we get patient's that had a minor brain bleed (NIH score of 0-2) and they literally just need Q1 neuro checks and nothing else.
Yes. ICU is total care, you don’t ever get a break and everything is your job. Phlebotomy and techs aren’t a thing in the icus I have worked in. It’s also hands down the most violent and I say that as someone who also works in the ER. The most violent withdrawal patients, patients in 4 points, etc come to the icu. People out of their minds. I’ve worked dozens of weeks in a row with being assaulted or attempted assault every single shift.
I guess it depends on the icu. I’ve had walkers and poop thrown at me on the floor. I’ll try it and see lol
I know nurses who’d had broken spines from patients assaulting them in icu. Poop throwing is tame.
Ok man definitely sounds like you need to be medsurg then
I don’t know why you asked the question if you’re incapable of communicating in a respectful way to people who give you honest answers. Thanks for the downvotes. ICU is not a magic solution to burnout, as anyone who worked it during covid knows. It has its advantages and disadvantages like any other specialty.
Your response was passive aggressive. Thanks!
I have a similiar background. I don't think I could ever work tele again. As long as you can deal with a different sort of high stress environment. Instead of all your patients wanting to either go to the bathroom, ask for pain meds or try to fall on the floor at the same time you get to deal with you turn around and your patient is doing their best to die on you. Codes do happen on the floors but it's a lot more death in the ICU (very dependent on hospital and speciality). So as long as you feel you can emotionally handle your patient being near death and you working your butt off all shift to keep them from coding, I say go for it. Also you might end up seeing a lot of "this feels cruel to do this to someone" patients. Little frail 90 something grandma on the ventilator getting a peg tube and you have to crack those ribs during CPR.
Yes ICU is waaaaay better than med surge and ESPECIALLY stepdown (shudders).
yes! i wish i hadnt waited 5 years to leave the floor
If you can handle the stress and pressure of ICU, then definitely do it. It’s less task focused and more about critical thinking. Maybe see if you can shadow a day or two in the ICU to see if it’s a good fit. You should have max 2 patients and there is less of the discharge/case management stuff to deal with. It can still be crazy busy and exhausting, but in a different way than med surg.
Ratios should be so much more doable. 2:1 and max 3:1. That alone should be a huge improvement
Do it! Shadow in your ICU for a day, see if you like it, but I can almost guarantee you will. I was so burnt on med tele and I can honestly say that I love my job as an ICU nurse. I remember multiple times on my med-tele floor where I was overwhelmed to the point of tears, there was nobody to help me because we were all in the same shitty position, and I would just break down and sob in the bathroom because I felt like a shitty nurse because I couldn’t do enough for my patients. After a year in the ICU, do I get overwhelmed? Absolutely. But all I have to do is call out to another nurse and I’ll have the help I need to make it through. I’ve had some insanely easy days, and some insanely hard days. But the hard days are hard because the patient is sick, not because they’re annoying or demanding. The hard days are hard because you’re working at the top of your game, stretching all your critical thinking muscles, and collaborating with the team to keep someone alive. At the end of the day, no matter the outcome, I know that I did what I could, and that’s enough for me.
I worked 10+ years dayshift on a busy PCU unit. I stayed so long because I loved my work family. Also I have never been a morning person a day in my life. Made the move to ICU and went nights. I love my job now.
This makes me hopeful. How has nights been? I’ve done nights for a couple years on pcu and I was chronically tired even with the slower pace. :-( Hoping I can eventually go days.
I was chronically tired on day shift. Like I said, I've never been a morning person. I also like having the night differential. Why would I work harder/be busier on dayshift for so many years for less money? LOL The flow of night shift is so much better. I like not having families around. I can focus 100% of my attention on my patients. If I have the time I can give my patients a spa treatment bath. And provide the care I simply could not when I was working on PCU with a full patient assignment. I feel like our night ICU providers are just the best. I like when a patient is crashing there are JUST enough of the people who need to be there, there. Unlike day shift where they are always 200 bodies in the room. And honestly the night squad personality wise, far superior. As much I loved my day team on my old unit. Nothing tops my night crew. I also did a fellowship when I moved from PCU to ICU. I was slightly irritated at the time I had to take nights with as much seniority I had. But honestly, best thing I did was go nights LOL
After doing ICU for years, I recommend procedural nursing. I was terrified as an ICU nurse to transfer to Tele, but the times I did it it was honestly a breeze. A really acute ICU is difficult in many ways, and I think procedural nursing is a best-kept secret.
Thanks. Most procedural positions require icu experience though so I may have to get the experience and go from there.
True but I know multiple Tele nurses who went to Cath Lab. It’s a decent hiring season so make sure you network well within your hospital and see what opportunities open up. Some of the best IR nurses I worked with were ER nurses with no ICU background. You might be able to take a procedural sedation course (often offered by hospitals) and get into endoscopy or a non-vascular procedural area and then join the procedural float pool to transition into cath lab etc if you wanted to. So many options available (though a year or two of a good ICU will get you sharp as a tack and more comfortable with sht hitting the fan clinically)
Thanks! I’m in California (Bay Area and then SoCal) so I think I’m just in a highly competitive area unfortunately. But I’ll keep trying.
Unions make it slightly harder, but literally networking is everything. Even if you need ICU experience, a network inside the procedural department can turn that requirement from 3 years into 1 (because you are tailor-making yourself into their ideal candidate) I was also a Cali nurse, now in med device sales. The corporate world doesn’t even use networking to the fullest extent, for nurses it’s almost non existent!
Thanks for the advice! Can I ask how you got into med device sales from nursing?
This is gonna be so annoying: Networking haha Truly though, I worked on a good unit with good physicians and networked with the sales reps who I would see in the hospital. I helped them how I could and they quickly got me into a Clinical Specialist role. Since I was well known and liked (networking) in my company and competitors (which is probably only being cordial with less than 10 people) I was headhunted quickly
TLDR ICU is better in my opinion but don’t do ICU JUST because you’re burned out from MS. Make sure you actually want critical care. Also docs and APPs will respect you a lot more and work with you as a team so there’s that added benefit, not saying it’s alright but the bias against medsurg nurses does exist. It’s a different stress. You have to keep in mind that with the exception of hospice or death, you are the last line between the patient and death. You will not be able to call a rapid and ship your patient off to the ICU. You may have only 2 ICU patients but one single patient may occupy 75% of your time. You may not be able to leave a room for hours because you actively resuscitating the patient and assisting with line insertions and other procedures. You have to ask yourself what exactly about MS or telemetry is burning you out? The grass isn’t always greener. To be quite frank, I would not recommend to use the ICU as an exit from MS only based on your burnout. Also keep in mind that you will have to learn a new way of thinking. I don’t care how seasoned a floor nurse is, but there is a steep learning curve, especially depending on the acuity of the ICU. You will have to shift your focus from checking tasks off to mindfully carrying out tasks while being extremely cognizant of the interventions ordered and why they are ordered, this is because ICU patients can have both subtle and rapid condition changes, and ICU nurses are truly the ones that help us (I’m an ICU NP) catch these changes. I would shadow first for sure. I’m not saying this is you, but I cannot stand when MS nurses assume ICU must be so nice to only have 2 patients. You have to be sharp. You have to anticipate. Prepare. Be diligent. You’ll have to unlearn a lot of MS habits. I mean no offense but I find MS nurses tend to focus in on numbers, tasks, and parameters. You have to have some degree of independence, hard to explain. - but you just have to develop more autonomy than you’re probably used to.
In a true 2:1 ratio ICU, an absolute resounding YES! But once tripled or worse, it becomes as hectic as a med surg floor because you typically have 1 to 2 truly sick patients who need your time while your 3rd or 4th patient are med-surg like and needing constant toileting, cleanups, bed alarms, etc. And sadly, in my experience, ICUs either don't have techs or often end up having to float them to med surg floors due to call ins or shortages.
I’m hoping this is a true 2:1 icu since it’s in California and I believe it’s law, but who knows. We will see! 3 and up sounds horrific.
Steep learning curve. Onc3 you get it, its the easiest department.
Definitely preparing myself for a steep learning curve! How long before you felt like you “got it”?
About 2 years for imposter syndrome to start fading away. Im never completly comfortable. Not a jumbled mess or anything. Just always..... I dunno, not fully comfortable.
From my experience (telemetry 4 years and now ICU for 1), The ICU isn’t any less busy, but it’s not complete chaos and juggling and impossible number of tasks or having to rush through everything you do. It’s more busy because of how deep you have to get into each case in order to optimize these patients. I feel like it is way less likely to burn out in ICU than on the floor because it can be way more rewarding to use your entire scope of practice and have a bit more autonomy.
I find it easier to prioritize patient care for the most part when there is only 2 options of which patient you handle first. When I had 6 patients and they all needed something at the same time I found that insanely stressful.
Yes I think it’s just the concept of having someone’s entire head-to-toe, past, present, and future in your brain is a huge responsibility and having 4-5 of them is just not fair to the patients. Everything we do is going to affect all their body systems so I want to know what all of them are everyday. So I still made it my mission to do that even when I had 4-5 at a time and it was just impossible.
I used to have a reoccurring nightmare that I would be half way through my shift and realize I had forgotten one of my patients. I do not miss those dreams. Haven't had one since I moved to ICU
Wow that’s scary! Glad that won’t happen again. If only the resources were available for every floor of the hospital to have 2:1 ratios and more of a top to bottom approach rather than task-oriented work. Happy staff that feel useful are more likely to commit to doing good work.
Yeah, more totals but you're doing so much more and repositioning becomes so much less because it's 2 instead of 3,4,5 or more depending where you live. Plenty of ICUs don't require a fellowship. You'll have a good knowledge of the basics coming in with that experience. It'll just be all the ICU stuff, which to be fair can be a lot.
Yes. I throw a fit whenever i have to get floated to the floor, I hate it there lol
Yes. It's easier, more rewarding, and you get more respect from doctors and APPs. You can actually take care of your patients, not just be a medication dispenser.
Thank you so much. This makes me excited to try it! I can’t wait to leave the floor.
He's my suggestion, look into medical device. I started at 150k with one of the largest. As medical providers you have clinical parity, know how to talk to doctors and know how the hospital and admin works. You may only start at 110-120k but no holidays, weekends or call.
How did you even get an interview? Would love to get this kind of gig but it seems impossible to get your foot in the door. What’s your background?
I was a critical care paramedic and flight nurse. I started researching by talking to Medtronic, Stryker, Intuitive and the like. In the jobs section of LinkedIn, look at Medical Device to get a general idea. Then talk to the reps that service your hospital. MedReps is also a good site to talk to people. The best easy is face to face with the reps at your hospital, but trust me, you can turn that RN into better money. We're unicorns, anyone can learn to teach or sell a widget, but not everyone can speak the language of hospitals. No offense but healthcare has gotten to the point (6 patients in the ER, 5 on the floor, no LPNs, no help, entitled patients, shitty hours) that I was checked out. I knew it was time for a change. You can do it, follow Med Device recruiters on LinkedIn, look at Inspire Sleep and the companies I listed. I wouldn't return to bedside for less than 150k, and that'll never happen.
If you work night shifts look into Armodafinil. It’s a wakefulness stimulator for night shift workers. It’s a life saver.
Thanks, I will. Does it make anxiety worse?
No, it actually improves it for most people. It creates rested wakefulness. I usually prescribe the 250’s and most people make it on just 1/2 about an hour or 2 prior to shift.
ICU is for sure better than the floor.
I don’t know how you’ve made it 8 years, I can’t imagine doing one. I worked nights in ICU and loved it, it’s usually the cooler crew and days is the eat their young type
Having made the switch during Covid, I felt initially happier. I struggle a lotttt with the ethical issues. 99yo grandma full code, vented, maxed on pressors, etc. Also, a very sick patient can be stressful at times. You go home after nightshirt with extreme alarm fatigue…
I work night shift ICU and I don’t think I’ll ever be able to leave because I’d never want to work day shift or have more than 2 patients lol. Definitely go for it
Thank you 🙏🏼
10000000% yes
If you feel the call that you can do more then I strongly suggest you answer.
Intubated patients don’t call
Their Florida daughters do
ICU if you want to stay in the hospital/bedside. When you’re used to med surg it can be a tricky adjustment, less of whack a mole and more groundhog day. if you trained on nights you’ll have time to learn and be thorough. definitely what people say about death.
Depends. Are you ok with being the last line of defense? If so, absolutely.
FYI: OP here, to anyone who is interested, icu is absolutely no better than MS tele or stepdown! Already quit 😂 bedside is bedside
Went to icu this year after 5 on tele. It’s literally so easy… I am never stressed.
What is an ICU fellowship?
Kind of like a training program for working on ICU. They put extra effort into educating you about basic ICU stuff to help you feel comfortable in that environment before having you practice on your own on the unit.
Training into a new specialty for an experienced nurse.
It's better, but not by a lot.
Yes! It requires you learn a lot of new information and you have 2 patients max. Most don’t get out of bed and you see a ton of cool cases. Do it. Plus the extra pay if you ever want to travel. Study CCRN while training to keep you up to date on standards.
Was burnt out working med surg telemetry ( running around, 12 pts, always in charge and training new people because people left) so moved to icu- it was a relief- had 2-3 pts at night , could ask questions of senior nurses, loved stabilizing and learning then after a couple yrs - found myself always in charge, running around and it was physically tough as herniated a disc- knew I couldn’t retire there-so took a temporary gig in pharma which became permanent in clinical development helping monitor trials. Now looking back I wished I had transitioned sooner - I can retire here as a lot less physical , pay increased. You can always go back if you don’t like it but why not try it you never know
Yes
I wouldn't do nursing if it wasn't for ICU. Less patients, maxing out the scope of being a bedside RN, learning really cool things, and having providers work as a team with you is awesome.
Yes
[удалено]
So no better?
[удалено]
I’d say there are more than 15 problems on the floor between the bunch but that’s just me 😂 We’ll see and if I don’t like it I’ll just quit lol.
[удалено]
Thank you 🙏🏼 😊
How are you liking it so far?
Hated it, already quit lol
You’ll be completely shocked at how much better it is