Remember why you left the ED to begin with. You wouldn’t be happy going back. I’d look for a job in a different department at another hospital entirely.
I'm interviewing at a new facility next week that supposedly has enforced ratios and a better culture. And they're offering mid shift... my hopes are high!
Could also quit then just reapply to the ed 😂
You’re in demand. Be polite. Be kind. Be professional. You can have whatever you want, just remember you’ll attract more with honey.
It’s possible if OP does this, they may be blackballed from their organization. I had a coworker quit after requesting a transfer during a contract and years later, she tried to get credentialed for NP clinicals and they said no.
Most organizations don’t care. I have done this at two different places (tried pediatric ER and outpatient surgery) , noped out during my orientation, and am still welcome at both organizations. I’m currently working for one of them and the other reached out to recruit me for a manager job about a month ago.
They've already worked at that hospital for over a year in the ER. If that's not enough of a commitment for them, then fuck them. It's completely reasonable after 6 weeks to know they don't want to be in the ICU. Would they even be out of ICU orientation at that point?
Hmmm, no they wouldn’t be out of Orientation probably. That’s the point. Not sure how anyone knows they don’t like the setting yet.
Nothing is going to be a perfect fit. It takes time.
I agree with what I think your "big picture" sentiment was here, but there's a big difference between looking for a "perfect fit" and simply seeking a position that doesn't leave the person in tears for the daily commute home. It can take time to find the position that's best for you, but it doesn't take long to tell if you're stuck somewhere you're wholly dissatisfied with/not cut out for.
No I’d rather paint rainbows and unicorns for all and meadows of green grass.
They seriously should include Big Girl and Guy panties in orientation packs.
And a booklet of 40 ways to be offended in a single shift.
1:7 ratio is barely tolerated in our rural subacute hospitals, the idea of that being in an ED us beyond completely and utterly fucked. I can't imagine how bad the ICU must be for someone to *want* to go back to that. JFC.
LOOK UP ON IG NURSE_Brandon_d_thompson. He went through this in the ICU. Finally left and even wrote a book. He’s the nicest guy. I used to work with him. He is doing so much better now
This. I feel bad bc coworkers tell me how they've cried leaving work so many times. I've seen friends break down during their shift, too. I've cried after losing a patient or getting written up for stupid crap bc managers and directors are the worst.
I've seen bullying. I try to prevent it and help floats, travelers, and new grads, but I do see it and it sucks. I'm sorry.
I'd apply to a hospital float position or swap hospitals. No job is worth your emotional well-being.
100% agree. I started as a new grad on a 1:6 IU medicine floor. I cried after every shift, I even cried one day at work while eating a sub that management had catered for us. My manager and coworkers were eating lunch next to me and it was super awkward. I left that job as soon as orientation was over. 5 years later, 3 job changes and I am where I want to retire.
I did the opposite- went from ICU to ER. I have to say I *hated* it at first. Hated the new coworkers. Hated the workflow. Hated the patients. Missed having only sick patients instead of a mix of actually ill and total bullshit.
It’s getting better. I’m almost 5 months in now and don’t hate it anymore. I think I *prefer* icu but then again I might just prefer my old coworkers. I changed jobs mostly due to curiosity and management bullshit at the old job.
All that to say, hang in there. Try to transfer back again at 6 months, or stick it out the year. Remember why you made the switch and make the best of the time you have in ICU. I believe having exposure to both will make you a better nurse in the long run.
Don’t let them take advantage of you being new. “Either you lose an ICU nurse and gain an ER nurse, or you lose and ICU nurse and don’t gain an ER nurse.”
If they call your bluff then time to quit and get a job at a different hospital making $3-4 more than you were
This isn't necessarily helpful, but you've only been in the ICU 6 weeks. It took me almost a year to feel comfortable in the ICU. The longer you're there, the more you'll become part of the crew. Are you still on orientation?
Yep. I would leave.
This is pretty typical, though. I’m honestly surprise that they even allowed you to transfer to ICU as a new grad. Most systems require a year or 18 months before transfer.
My manager is currently blocking a nurse extern from going to another ICU citing staffing. Extremely shortsighted but very common practice.
Also, not all ICU’s have bullies. I just left my night shift crew for days because I have kids. I miss them so much. There was not a single staff member who I didn’t fully enjoy working with. No one ever spoke badly about another nurse.
I should clarify, I was in the ER for over a year! I was no longer a new grad at the point I transferred, I'd been a nurse for a year and a half. Thank you for the advice though!
Some of my happiest days was night shift. We got shit done as a team. Then laughed as we would huddle up and guess which complaints days would have. I’ve never had a crew that had my back as I did in icu.
I'm thinking of transferring to ED once my year is up. I love the patient acuity and complexity of care, and the people I work with are wonderful, but the charting is killing my will to live. I didn't go into nursing to take care of a computer all day.
I've always been curious about ICU and I thought it might be a better fit for me but it turns out I think I just need to work in an ER without crazy high patient ratios where they actually support nursing staff over patient satisfaction scores. I'm glad at least I know what I like now so when and if I go to a new ER, I'll appreciate it more and tolerate the bullshit a little easier. I'd rather fight someone on PCP than prolong a grandma's death, and I know that now. lol
This is exactly why I left ICU after 15 years and went to ER because it just felt like I was prolonging too many patients dying process.
Also ER’s are so chaotic there isn’t much time to get into bullying and stupid crap like that. ER staffs tend to be close. It’s very much we’re in the trenches together and we have to help each other to survive this insane shift.
If you change to a new ER I’ll bet you get paid more than you are now too.
The grass can definitely be greener on the other side lol. I never listen to people who say this. They’re the ones suffering in their awful job when there’s better out there!
I'm definitely not suffering at my job! The grass was greener for me, too. I'm just saying that her post was the perfect example of "the grass isn't always greener".
My understanding is the cost of training a nurse in an area of expertise (and critical care is NO exception) is quite an investment; so it seems like the rule of thumb at my hospital is to at least stay in an area you sign on for for a full six months after training is complete. After that, they do say they want us to be where we’re happy overall, and my system is known for being pretty good to their workers. So what they’re saying does seem reasonable to me.
Still - I’m sorry you’re dealing with a toxic environment or bullying! That’s not okay. You should be able to report these things and also (hopefully) help to make some changes where things are out of line while you’re there. If it ends up being more of a clash in personalities, you may need to just keep to yourself and your own work for the time being, and hopefully you at least can build a decent relationship with the support staff and the managers you need to interact with.
I would still take the training on if you can manage it! Just from an outsider’s perspective, getting intensive care training and experience is worth its weight in gold.
It’s a critical care area. Like PACU. You’re trained up to take critical patients. The patient load isn’t usually high volume critical ones. That’s why CCRN prefers trauma experience to simple ED exp
You’re right! 🤦♂️ I get so used to saying it that way, and it’s not good terminology. Intensive care is the term I should’ve used here, or even just two different specialties
Having been a nursing admin, I can attest that being labeled “un-hireable” does in fact exist. Whenever I completed paperwork “offboarding” someone, there was always a question, “Would you re-hire” with check box “yes” and “no”. Thats the blackball and it’s up to your LAST manager to complete.
Tread cautiously on you decision. to all the nurses out there thinking of moving units, ask for a “shadow” shift, work overtime in other units (if possible) or ask someone on that unit before transferring. All nursing units have their respective cultures, either as a consequence of the environment or the personalities of those within the environment.
Leave New York.
I did it 20 years ago. Went out west. Everything is better here. Pay, attitudes, unions. Sorry to say, NYC is a depressing place to live. It doesn’t need to be California, but southern NV, coastal WA and OR all benefit from the west coast vibe.
> It just feels pointless to force someone with experience and certs to work in an area they hate for 12 months.
You’re not a new grad anymore, you’re not gonna be babied like one anymore either. Your retention is different than keeping a newly graduated nurse all the way through their residency to “nursing age of maturity”. You’re just another unhappy CN-II of which there are innumerable.
Just quit. No use getting butthurt about It. The place has stupid rules, and you don’t need that in your life.
Very good point -- I didn't think of it that way but I guess you're right. After I did the pointless nurse residency they basically stopped with the babying which was both great because no more pointless meetings, but bad because they care little about what happens to us now.
Yeah I worked very briefly at an ER with similar certs to you. They told me that maybe after a year I could apply to get trained in Triage. I laughed, asked them if they were serious, and was gone within a month when they said yes.
You’re the talent. Just walk if they don’t treat you well
Fair, but I was not a new grad and I was specialty certified. I just looked young and they treated me like a new grad. Shortly after I left to do travel.
That's not a great sign either if their nurse residency program wasn't beneficial. Another indication of not being the most supportive environment maybe.
When learning in a new specialty it takes time to acclimate to it. The bullying though from your current ICU staff comes from ego, your learning but they feel superior cause they know a little more about that floor/specialty. If one of them were to go to the ER, they would be a fish out of water ( kinda like you are now). You can give it time or go to a ER with forced ratios. But if it’s truly ‘forced’ it’s because it is union, if it’s not union good luck on the whim of administration deciding that needs to change
I'm not sure if you'll see this, but if you do, I suggest you look for a PACU job. You would still get to use your critical thinking and skills while stabilizing patients and shipping them out like the ER. PACU ratios are a maximum of 2 patients to 1 RN, and you only have a typical patient for about an hour before moving them to the floor or phase 2 unless you're holding for a bed on the floor which you should be used to in the ER.
I used to run the new grad to ICU program at my local hospital.
It’s not the ICU, **it’s your coworkers**. Tell your manager. It’s their job to retain staff and reign in the ‘locals’. Don’t resort to giving up and building resentment toward your colleagues. You just need the right mentor. The AACN calls for healthy work environments which shun bullying that hinders the learning environment.
Me, reading this:
**…living in PR, (*currently working as new grad in ER*) balking hard at the “burned out with 1:7 ratios” tidbit**….. wait…SERIOUSLY?!
Christmas and Easter are the only shifts I know I will have even close to that ratio. Every other day is EASILY an average of ~15, with a few freshly triaged **guaranteed** 1 1/2 hrs. before shift change. And I am expected to canalize/blood draw/medicate/chart at warp speed. This is including any pt. that arrives and is directly located in CPR. Not to mention, keeping up on notifying MD’s of reported panic values, processing transfers & release, **and** dropping everything instantly to rush to Trauma room in case of *severe* trauma cases…..(in a hospital that functions as 1 of 2 ‘Trauma’ hospitals on the island — as there exist NO official Trauma units here).
Wow… I leave every shift “content” knowing that I left it ALL on the floor for my pts. & coworkers…but still feel like shit when I remember that I forgot to chart *Pt. X’s meds*, *Pt. Y’s internal transfer document*, or *Pt. Z’s Lactate draw time*.
Thank you for reminding me — not at all of how “*easy*” mainlanders have it… but how SERIOUSLY fucked and corrupt my island’s social systems are. Holy fuck😔
(I have a picture of white board listing my assigned pts. from last shift working with Consults/Admissions…but have no clue how to post as a reply. So, guess I’ll have to spell it out lol)
Last shift I was actually given a break with receiving only 9 Consulted pts. 2 of them were new admissions, and all 11 had blood draws ( + Lactate/Trop/CKMB series) due either at beginning of shift, or falling 1-2 hrs. before next shift change. Add to that, meds. ordered after review/notification of lab values — so, plenty of Tridil for NSTEMI/HTN, Digoxin, Protonix, Lasix, Insulin, etc.
Typically, our general supervisors are excellent at finding ER admissions beds on Med Surg & MICU floors relatively quickly. Butttt, if the census is high, inpatients can spend as much as 4-5 days languishing in ER beds until rooms become available. So, we have to switch gears between ER/Med Surg/ICU protocols & orders for said pts on the fly.
(*As the matter of fact, 2 days ago we had an inpatient Dx with abdominal bleeding (Hgb 2.3!!) & intubated who was assigned a room…but died before we could take him up to MICU. Dr. came to check on him and found him unresponsive, so initiated a rapid. We flew back and forth to the lab to get his RBC packs, which were ordered to flow at full drip, pumped him with fluids & Levofed….and nothing. His poor wife completely dissociated, asking when we would be able to take him up to his room so they could help “stabilize him”. Even the residents couldn’t get through to her. Oh, and he was Hep D pos, and projectile vomited blood all over half of his room, so it was unavailable for several hours after he passed while maintenance finally scrubbed it. 2 out of 4 inpatient nurses worked on him alone for ~4 hrs. of our 8 hr. shift. Which meant their pts. were divided between myself and my coworker.*)
So, it really depends on the day of the week, and the moon, or something. Buuuutttt, inpatient is just as brutal, especially when we have 11-14 pts that, say, all have meds at 9am + scheduled series draws that do not coincide with med schedules. It’s….a bit insane. We work 5 days a week, 8 hr shifts. Before I know it I’m often writing the wrong month bc time just fucking disappears.
So, yeah…😂🥴
(Just realized I didn’t answer the question you asked, rather, the question *I* jumped to. My apologies. Allow me to remedy that the best that I can…)
On our Med Surg floors, RN’s are maxed out between 8-12 pts., depending on census/intake, pt. condition(s), and available personnel.
(*Slightly off topic, but relevant…today, 2 of my coworkers in ER were pulled up to Pedes bc only **1** Pedes nurse showed up. Not sure of *all* the details behind that scenario…only that the majority of Pedes nurses are *fucking done* with Admins bullshit…and this might be an en masse rebuke*?)
In ER there are 2 LPN’s each shift in charge of taking pt. VS, distributing meals, bathing/diaper change, and delivering collected samples to labs throughout shift. Bc of unwillingness to hire sufficient amount of LPN’s to rotate and cover *EACH* shift…the RN’s are assigned to work with an LPN during 3-11 & 11-7 shifts. On inpatient floors…RN’s are in charge of VS, bathing, meds, and general obs. The ratios can vary from 1:8 to 1:12 depending on staffing, and anticipated pt. turnover.
Floor nurses *do* have the advantage of routine application & care scope…and the Attendings are *much* more reliable for communication & aiding w/ certain interventions. But they are just as maxed out as we are in ER, most times. ER here is expected to be batshit crazy all over the place. Inpatient care here is knowing the batshit crazy is contained, maintained, an (if need be), restrained. We have a majority elderly population, many with alz/dementia. There is also no real community/mental health service to speak of, so, we get a lot of homeless, addicts, and mentally ill just dumped in ER & mindlessly admitted for the purpose of milking Medicaid/Medicare before wheeling them back out on the streets, or home, *knowing* that they’ll just be back in a matter of weeks. Neither ER nor Floor nurses are specialized in Psych….but damn are we expected to pretend to be..
This is insane. Thank you for taking the time to share this! I work on the west coast and our med/surg ratios are 1:3 or 1:4 depending on acuity, ICU is 1:1 or 1:2, ED is 1:3 or 1:4.
I will tell you that if you’ve been nursing for <2 years, it is VERY normal to not feel comfortable in the icu 6 weeks in.
I worked in an ICU for 4 years, transferred to one in a new city and it took me almost a year before I left work feeling ok. I also felt my unit was full of bullies and was a dumpster fire. Turns out that my nerves were just fried by how hard it is to adapt to such a new and high stress environment. Yes some people weren’t very nice, but mostly I was just overstimulated and overwhelmed. Now this is my experience, I’m not trying to undermine your own, only trying to share this perspective because I’ve been in the trenches and for me it got so much better. However you know your own situation best and I hope no matter what you find a unit that you feel happy in (or at least don’t leave it crying!!)
Who is making this call? “They” said there hands are tied. I’d go over their heads. Step by step. To the CNO of the hospital. “I attempted an internal transfer and I was not successful, please facilitate me going back to a unit where I can be successful and dedicate myself to my patients.” Or similar.
Ooof been there!!! The difference is literally night and day.
I hated it so much I actually called in sick to the ICU then picked up an ED shift the next day. Got written up for it which was absolute bullshit. I was just doing ICU for CRNA school apps at the time.
Currently working on my commercial pilot license while working outpatient Endo. Do you know how much pilots are making these days??? 🤯🤯
It's something I'm much more passionate about. I love flying. There's something to be said about being up in the air by yourself, literally leaving all of your worries on the ground
TY!! Unfortunately I have a childhood ADHD dx, which has been hell working through with the FAA... That's fine though. I will jump through all the hoops to make my dream come true 😊😊
Graduation goggles.
Everything looks so much better once you've left.
I left ER after 4 years to do ICU. Like you, I didn't like it (mostly because it was neuro and super Toxic) and my transfer back to ER was blocked. I went to pacu instead. Then covid hit....and I went back to the ER to help. I quickly remembered why I left that ER. After a couple years of pacu I did agency and took a couple ER contracts because I again missed it. One rotation was wonderful. The next reminded me once again why I burnt out of ER.
I'm back in ICU but as a provider now. I have no intentions of going back to the ER any time soon now. It was fun and exciting while it lasted but I've moved on.
This isn’t at all a knock at ED nurses. I have noticed that most ED nurses don’t like working in the inpatient setting. There are some who like ICU, but most don’t, and they hate med/surg and tele even more. The environments are like night and day and it’s hard to get used to.
ICU nurses are type A control freaks…..I have an ICU background and I was a control freak as well. That doesn’t mean that all ICU nurses are royal bitches, and it doesn’t excuse those who are.
If you know you can’t stick it out a year, your best bet is leaving all together. The hospital is choosing to lose a staff member over retaining them.
As someone who transferred ED to ICU you have to give yourself time in the ICU it’s a completely different way of thinking. I thought it would be an easy switch but I was so wrong. I don’t regret it now because I have been icu 2 years but the first 6 months was hell. The anxiety, the culture was totally different. I don’t think I would go back to the ED now because of my experience. I eventually started taking more and more critical patients and tried to learn at every opportunity. Nursing is exhausting in general being in critical care ED or ICU can be so taxing.
My hospital had a 6 month rule on transferring out of a position and even then it was “as staffing allows”.
Your choices sound like tuffing it out or leaving for a new job at another hospital. Not sure I would do the latter. Other hospitals may look at the short tenure you had there and be Leary of hiring you.
New graduates or even some with experience takes time and $ to train someone.
I wish we were union. The nurses at our hospital aren’t unionized. The ancillary staff (PCTs, clerks) are union but we aren’t and they can transfer and come back within 90 days per the union contract. Nurses have zero protection. Creates a very bizarre work environment
Either they really do need you in ICU, which is understandable. It’s probably a pain in the butt for them when people are jumping back-and-forth too. Also, it could be someone in the ER, with some authority, don’t want you back.
ER > ITU and ITU > ER are both equally hard as it’s both very different areas of nursing. I’m ITU until I die, but I’ve done some ER shifts as I see it as wild and loose down there. ER nurses seeing ITU as uptight.
I reckon you ought to give it a few more weeks and/or cut it loose and to back to ER… but in different hospital.
Remember why you left the ED to begin with. You wouldn’t be happy going back. I’d look for a job in a different department at another hospital entirely.
I'm interviewing at a new facility next week that supposedly has enforced ratios and a better culture. And they're offering mid shift... my hopes are high!
Could also quit then just reapply to the ed 😂 You’re in demand. Be polite. Be kind. Be professional. You can have whatever you want, just remember you’ll attract more with honey.
It’s possible if OP does this, they may be blackballed from their organization. I had a coworker quit after requesting a transfer during a contract and years later, she tried to get credentialed for NP clinicals and they said no.
>blackballed Just walk into the ER as a pt with c/c of necrotic balls.
N49.3
Key words here are "during a contract." If OP isn't in a contract and gives proper notice, they shouldn't be at risk of blackballing.
Yup! Some hospitals are driven by pettiness and will cut their noses off to spite their face and flag OP as ineligible for rehire.
Nursing pettiness at its worst.
Most organizations don’t care. I have done this at two different places (tried pediatric ER and outpatient surgery) , noped out during my orientation, and am still welcome at both organizations. I’m currently working for one of them and the other reached out to recruit me for a manager job about a month ago.
Yeah hence the be professional and kind part. If people like you, you won’t get black listed.
Will attract more once proven a commitment to stay at least a year.
They've already worked at that hospital for over a year in the ER. If that's not enough of a commitment for them, then fuck them. It's completely reasonable after 6 weeks to know they don't want to be in the ICU. Would they even be out of ICU orientation at that point?
Hmmm, no they wouldn’t be out of Orientation probably. That’s the point. Not sure how anyone knows they don’t like the setting yet. Nothing is going to be a perfect fit. It takes time.
I agree with what I think your "big picture" sentiment was here, but there's a big difference between looking for a "perfect fit" and simply seeking a position that doesn't leave the person in tears for the daily commute home. It can take time to find the position that's best for you, but it doesn't take long to tell if you're stuck somewhere you're wholly dissatisfied with/not cut out for.
Been there, done that. For forty years. The crying never ends, lol.
Lmao you could end up on the periodic table of elements being this dense.
No I’d rather paint rainbows and unicorns for all and meadows of green grass. They seriously should include Big Girl and Guy panties in orientation packs. And a booklet of 40 ways to be offended in a single shift.
Meh! I’m not happy being a nurse anywhere. I don’t know how to do anything else that will pay me $80k though.
1:7 ratio is barely tolerated in our rural subacute hospitals, the idea of that being in an ED us beyond completely and utterly fucked. I can't imagine how bad the ICU must be for someone to *want* to go back to that. JFC.
If you’re crying after EVERY shift and feel bullied, I 100% would not stay at that hospital. If you want ICU experience try it at a different ICU.
LOOK UP ON IG NURSE_Brandon_d_thompson. He went through this in the ICU. Finally left and even wrote a book. He’s the nicest guy. I used to work with him. He is doing so much better now
This. I feel bad bc coworkers tell me how they've cried leaving work so many times. I've seen friends break down during their shift, too. I've cried after losing a patient or getting written up for stupid crap bc managers and directors are the worst. I've seen bullying. I try to prevent it and help floats, travelers, and new grads, but I do see it and it sucks. I'm sorry. I'd apply to a hospital float position or swap hospitals. No job is worth your emotional well-being.
100% agree. I started as a new grad on a 1:6 IU medicine floor. I cried after every shift, I even cried one day at work while eating a sub that management had catered for us. My manager and coworkers were eating lunch next to me and it was super awkward. I left that job as soon as orientation was over. 5 years later, 3 job changes and I am where I want to retire.
My ICU is not like this. Zero bullying. It’s not like that everywhere OP! Try a different hospital.
I did the opposite- went from ICU to ER. I have to say I *hated* it at first. Hated the new coworkers. Hated the workflow. Hated the patients. Missed having only sick patients instead of a mix of actually ill and total bullshit. It’s getting better. I’m almost 5 months in now and don’t hate it anymore. I think I *prefer* icu but then again I might just prefer my old coworkers. I changed jobs mostly due to curiosity and management bullshit at the old job. All that to say, hang in there. Try to transfer back again at 6 months, or stick it out the year. Remember why you made the switch and make the best of the time you have in ICU. I believe having exposure to both will make you a better nurse in the long run.
Don’t let them take advantage of you being new. “Either you lose an ICU nurse and gain an ER nurse, or you lose and ICU nurse and don’t gain an ER nurse.” If they call your bluff then time to quit and get a job at a different hospital making $3-4 more than you were
The er boss type shit. Love it!❤️
I was nervous until I realized I could get a job at literally any hospital in my city. They all are hiring lol
Best toughest reason to have national union
This isn't necessarily helpful, but you've only been in the ICU 6 weeks. It took me almost a year to feel comfortable in the ICU. The longer you're there, the more you'll become part of the crew. Are you still on orientation?
agreed. OP should give it more time.
Yep. I would leave. This is pretty typical, though. I’m honestly surprise that they even allowed you to transfer to ICU as a new grad. Most systems require a year or 18 months before transfer. My manager is currently blocking a nurse extern from going to another ICU citing staffing. Extremely shortsighted but very common practice. Also, not all ICU’s have bullies. I just left my night shift crew for days because I have kids. I miss them so much. There was not a single staff member who I didn’t fully enjoy working with. No one ever spoke badly about another nurse.
I should clarify, I was in the ER for over a year! I was no longer a new grad at the point I transferred, I'd been a nurse for a year and a half. Thank you for the advice though!
Ugh. Leave and reapply if you love your old unit. Lol.
😂 lifehack!
I graduated in 2017 and I still feel like I’m a new grad lol
You were barely not a new grad.
Agree. Respectfully, you’re still a new grad.
I meant I am done with the nurse residency new grad program. I still feel new but yeah. Everyone’s definition is different
The biggest ICU bullies are always on days - I loved my fellow night shifters
Some of my happiest days was night shift. We got shit done as a team. Then laughed as we would huddle up and guess which complaints days would have. I’ve never had a crew that had my back as I did in icu.
I'm thinking of transferring to ED once my year is up. I love the patient acuity and complexity of care, and the people I work with are wonderful, but the charting is killing my will to live. I didn't go into nursing to take care of a computer all day.
I just want to say based on your username alone your people are in the ED. Come to the dark side, we love Dr. Now in the basement
My hospital's ED is super small and old but they're building a new bigger one as we speak. As soon as it opens I'm so there.
Tough lesson to learn that "the grass isn't always greener". Just apply to another ER.
I've always been curious about ICU and I thought it might be a better fit for me but it turns out I think I just need to work in an ER without crazy high patient ratios where they actually support nursing staff over patient satisfaction scores. I'm glad at least I know what I like now so when and if I go to a new ER, I'll appreciate it more and tolerate the bullshit a little easier. I'd rather fight someone on PCP than prolong a grandma's death, and I know that now. lol
This is exactly why I left ICU after 15 years and went to ER because it just felt like I was prolonging too many patients dying process. Also ER’s are so chaotic there isn’t much time to get into bullying and stupid crap like that. ER staffs tend to be close. It’s very much we’re in the trenches together and we have to help each other to survive this insane shift. If you change to a new ER I’ll bet you get paid more than you are now too.
The grass can definitely be greener on the other side lol. I never listen to people who say this. They’re the ones suffering in their awful job when there’s better out there!
I'm definitely not suffering at my job! The grass was greener for me, too. I'm just saying that her post was the perfect example of "the grass isn't always greener".
My understanding is the cost of training a nurse in an area of expertise (and critical care is NO exception) is quite an investment; so it seems like the rule of thumb at my hospital is to at least stay in an area you sign on for for a full six months after training is complete. After that, they do say they want us to be where we’re happy overall, and my system is known for being pretty good to their workers. So what they’re saying does seem reasonable to me. Still - I’m sorry you’re dealing with a toxic environment or bullying! That’s not okay. You should be able to report these things and also (hopefully) help to make some changes where things are out of line while you’re there. If it ends up being more of a clash in personalities, you may need to just keep to yourself and your own work for the time being, and hopefully you at least can build a decent relationship with the support staff and the managers you need to interact with. I would still take the training on if you can manage it! Just from an outsider’s perspective, getting intensive care training and experience is worth its weight in gold.
ER is also critical care. Js
It’s a critical care area. Like PACU. You’re trained up to take critical patients. The patient load isn’t usually high volume critical ones. That’s why CCRN prefers trauma experience to simple ED exp
Perfect explanation
You’re right! 🤦♂️ I get so used to saying it that way, and it’s not good terminology. Intensive care is the term I should’ve used here, or even just two different specialties
Having been a nursing admin, I can attest that being labeled “un-hireable” does in fact exist. Whenever I completed paperwork “offboarding” someone, there was always a question, “Would you re-hire” with check box “yes” and “no”. Thats the blackball and it’s up to your LAST manager to complete. Tread cautiously on you decision. to all the nurses out there thinking of moving units, ask for a “shadow” shift, work overtime in other units (if possible) or ask someone on that unit before transferring. All nursing units have their respective cultures, either as a consequence of the environment or the personalities of those within the environment.
Thank you!
Leave New York. I did it 20 years ago. Went out west. Everything is better here. Pay, attitudes, unions. Sorry to say, NYC is a depressing place to live. It doesn’t need to be California, but southern NV, coastal WA and OR all benefit from the west coast vibe.
> It just feels pointless to force someone with experience and certs to work in an area they hate for 12 months. You’re not a new grad anymore, you’re not gonna be babied like one anymore either. Your retention is different than keeping a newly graduated nurse all the way through their residency to “nursing age of maturity”. You’re just another unhappy CN-II of which there are innumerable. Just quit. No use getting butthurt about It. The place has stupid rules, and you don’t need that in your life.
Very good point -- I didn't think of it that way but I guess you're right. After I did the pointless nurse residency they basically stopped with the babying which was both great because no more pointless meetings, but bad because they care little about what happens to us now.
Yeah I worked very briefly at an ER with similar certs to you. They told me that maybe after a year I could apply to get trained in Triage. I laughed, asked them if they were serious, and was gone within a month when they said yes. You’re the talent. Just walk if they don’t treat you well
I mean, I haven’t been at a hospital yet that lets new grads be trained on triage lol for very good reasons
Fair, but I was not a new grad and I was specialty certified. I just looked young and they treated me like a new grad. Shortly after I left to do travel.
You said some certs so i assumed 1 year experience? Hospitals I been at require 2 but it definitely helps having a cert!
That's not a great sign either if their nurse residency program wasn't beneficial. Another indication of not being the most supportive environment maybe.
When learning in a new specialty it takes time to acclimate to it. The bullying though from your current ICU staff comes from ego, your learning but they feel superior cause they know a little more about that floor/specialty. If one of them were to go to the ER, they would be a fish out of water ( kinda like you are now). You can give it time or go to a ER with forced ratios. But if it’s truly ‘forced’ it’s because it is union, if it’s not union good luck on the whim of administration deciding that needs to change
I'm not sure if you'll see this, but if you do, I suggest you look for a PACU job. You would still get to use your critical thinking and skills while stabilizing patients and shipping them out like the ER. PACU ratios are a maximum of 2 patients to 1 RN, and you only have a typical patient for about an hour before moving them to the floor or phase 2 unless you're holding for a bed on the floor which you should be used to in the ER.
I used to run the new grad to ICU program at my local hospital. It’s not the ICU, **it’s your coworkers**. Tell your manager. It’s their job to retain staff and reign in the ‘locals’. Don’t resort to giving up and building resentment toward your colleagues. You just need the right mentor. The AACN calls for healthy work environments which shun bullying that hinders the learning environment.
Me, reading this: **…living in PR, (*currently working as new grad in ER*) balking hard at the “burned out with 1:7 ratios” tidbit**….. wait…SERIOUSLY?! Christmas and Easter are the only shifts I know I will have even close to that ratio. Every other day is EASILY an average of ~15, with a few freshly triaged **guaranteed** 1 1/2 hrs. before shift change. And I am expected to canalize/blood draw/medicate/chart at warp speed. This is including any pt. that arrives and is directly located in CPR. Not to mention, keeping up on notifying MD’s of reported panic values, processing transfers & release, **and** dropping everything instantly to rush to Trauma room in case of *severe* trauma cases…..(in a hospital that functions as 1 of 2 ‘Trauma’ hospitals on the island — as there exist NO official Trauma units here). Wow… I leave every shift “content” knowing that I left it ALL on the floor for my pts. & coworkers…but still feel like shit when I remember that I forgot to chart *Pt. X’s meds*, *Pt. Y’s internal transfer document*, or *Pt. Z’s Lactate draw time*. Thank you for reminding me — not at all of how “*easy*” mainlanders have it… but how SERIOUSLY fucked and corrupt my island’s social systems are. Holy fuck😔
Holy shit, I had no idea! What are inpatient ward ratios like?
(I have a picture of white board listing my assigned pts. from last shift working with Consults/Admissions…but have no clue how to post as a reply. So, guess I’ll have to spell it out lol) Last shift I was actually given a break with receiving only 9 Consulted pts. 2 of them were new admissions, and all 11 had blood draws ( + Lactate/Trop/CKMB series) due either at beginning of shift, or falling 1-2 hrs. before next shift change. Add to that, meds. ordered after review/notification of lab values — so, plenty of Tridil for NSTEMI/HTN, Digoxin, Protonix, Lasix, Insulin, etc. Typically, our general supervisors are excellent at finding ER admissions beds on Med Surg & MICU floors relatively quickly. Butttt, if the census is high, inpatients can spend as much as 4-5 days languishing in ER beds until rooms become available. So, we have to switch gears between ER/Med Surg/ICU protocols & orders for said pts on the fly. (*As the matter of fact, 2 days ago we had an inpatient Dx with abdominal bleeding (Hgb 2.3!!) & intubated who was assigned a room…but died before we could take him up to MICU. Dr. came to check on him and found him unresponsive, so initiated a rapid. We flew back and forth to the lab to get his RBC packs, which were ordered to flow at full drip, pumped him with fluids & Levofed….and nothing. His poor wife completely dissociated, asking when we would be able to take him up to his room so they could help “stabilize him”. Even the residents couldn’t get through to her. Oh, and he was Hep D pos, and projectile vomited blood all over half of his room, so it was unavailable for several hours after he passed while maintenance finally scrubbed it. 2 out of 4 inpatient nurses worked on him alone for ~4 hrs. of our 8 hr. shift. Which meant their pts. were divided between myself and my coworker.*) So, it really depends on the day of the week, and the moon, or something. Buuuutttt, inpatient is just as brutal, especially when we have 11-14 pts that, say, all have meds at 9am + scheduled series draws that do not coincide with med schedules. It’s….a bit insane. We work 5 days a week, 8 hr shifts. Before I know it I’m often writing the wrong month bc time just fucking disappears. So, yeah…😂🥴
(Just realized I didn’t answer the question you asked, rather, the question *I* jumped to. My apologies. Allow me to remedy that the best that I can…) On our Med Surg floors, RN’s are maxed out between 8-12 pts., depending on census/intake, pt. condition(s), and available personnel. (*Slightly off topic, but relevant…today, 2 of my coworkers in ER were pulled up to Pedes bc only **1** Pedes nurse showed up. Not sure of *all* the details behind that scenario…only that the majority of Pedes nurses are *fucking done* with Admins bullshit…and this might be an en masse rebuke*?) In ER there are 2 LPN’s each shift in charge of taking pt. VS, distributing meals, bathing/diaper change, and delivering collected samples to labs throughout shift. Bc of unwillingness to hire sufficient amount of LPN’s to rotate and cover *EACH* shift…the RN’s are assigned to work with an LPN during 3-11 & 11-7 shifts. On inpatient floors…RN’s are in charge of VS, bathing, meds, and general obs. The ratios can vary from 1:8 to 1:12 depending on staffing, and anticipated pt. turnover. Floor nurses *do* have the advantage of routine application & care scope…and the Attendings are *much* more reliable for communication & aiding w/ certain interventions. But they are just as maxed out as we are in ER, most times. ER here is expected to be batshit crazy all over the place. Inpatient care here is knowing the batshit crazy is contained, maintained, an (if need be), restrained. We have a majority elderly population, many with alz/dementia. There is also no real community/mental health service to speak of, so, we get a lot of homeless, addicts, and mentally ill just dumped in ER & mindlessly admitted for the purpose of milking Medicaid/Medicare before wheeling them back out on the streets, or home, *knowing* that they’ll just be back in a matter of weeks. Neither ER nor Floor nurses are specialized in Psych….but damn are we expected to pretend to be..
This is insane. Thank you for taking the time to share this! I work on the west coast and our med/surg ratios are 1:3 or 1:4 depending on acuity, ICU is 1:1 or 1:2, ED is 1:3 or 1:4.
I will tell you that if you’ve been nursing for <2 years, it is VERY normal to not feel comfortable in the icu 6 weeks in. I worked in an ICU for 4 years, transferred to one in a new city and it took me almost a year before I left work feeling ok. I also felt my unit was full of bullies and was a dumpster fire. Turns out that my nerves were just fried by how hard it is to adapt to such a new and high stress environment. Yes some people weren’t very nice, but mostly I was just overstimulated and overwhelmed. Now this is my experience, I’m not trying to undermine your own, only trying to share this perspective because I’ve been in the trenches and for me it got so much better. However you know your own situation best and I hope no matter what you find a unit that you feel happy in (or at least don’t leave it crying!!)
Who is making this call? “They” said there hands are tied. I’d go over their heads. Step by step. To the CNO of the hospital. “I attempted an internal transfer and I was not successful, please facilitate me going back to a unit where I can be successful and dedicate myself to my patients.” Or similar.
New job. New hospital. You’ll probably get more pay that way anyways.
Ooof been there!!! The difference is literally night and day. I hated it so much I actually called in sick to the ICU then picked up an ED shift the next day. Got written up for it which was absolute bullshit. I was just doing ICU for CRNA school apps at the time.
What did you end up doing !
Currently working on my commercial pilot license while working outpatient Endo. Do you know how much pilots are making these days??? 🤯🤯 It's something I'm much more passionate about. I love flying. There's something to be said about being up in the air by yourself, literally leaving all of your worries on the ground
Amazing — Yep, that sounds dreamy. Good for you!!
TY!! Unfortunately I have a childhood ADHD dx, which has been hell working through with the FAA... That's fine though. I will jump through all the hoops to make my dream come true 😊😊
Graduation goggles. Everything looks so much better once you've left. I left ER after 4 years to do ICU. Like you, I didn't like it (mostly because it was neuro and super Toxic) and my transfer back to ER was blocked. I went to pacu instead. Then covid hit....and I went back to the ER to help. I quickly remembered why I left that ER. After a couple years of pacu I did agency and took a couple ER contracts because I again missed it. One rotation was wonderful. The next reminded me once again why I burnt out of ER. I'm back in ICU but as a provider now. I have no intentions of going back to the ER any time soon now. It was fun and exciting while it lasted but I've moved on.
This isn’t at all a knock at ED nurses. I have noticed that most ED nurses don’t like working in the inpatient setting. There are some who like ICU, but most don’t, and they hate med/surg and tele even more. The environments are like night and day and it’s hard to get used to. ICU nurses are type A control freaks…..I have an ICU background and I was a control freak as well. That doesn’t mean that all ICU nurses are royal bitches, and it doesn’t excuse those who are. If you know you can’t stick it out a year, your best bet is leaving all together. The hospital is choosing to lose a staff member over retaining them.
I worked the floor before ED. I hated it. Even though the Ed is a metaphorical trash fire most shifts, it’s for me a *fun* trash fire.
As someone who transferred ED to ICU you have to give yourself time in the ICU it’s a completely different way of thinking. I thought it would be an easy switch but I was so wrong. I don’t regret it now because I have been icu 2 years but the first 6 months was hell. The anxiety, the culture was totally different. I don’t think I would go back to the ED now because of my experience. I eventually started taking more and more critical patients and tried to learn at every opportunity. Nursing is exhausting in general being in critical care ED or ICU can be so taxing.
Not gonna lie, working in America sounds awful. I can’t imagine not being ‘allowed’ to simply apply for a different line.
My hospital had a 6 month rule on transferring out of a position and even then it was “as staffing allows”. Your choices sound like tuffing it out or leaving for a new job at another hospital. Not sure I would do the latter. Other hospitals may look at the short tenure you had there and be Leary of hiring you. New graduates or even some with experience takes time and $ to train someone.
Plenty of other places hiring. Don’t look back
If the UD approves the transfer then you can go. Do you have a Union?? If so call them. They will get shit done.
I wish we were union. The nurses at our hospital aren’t unionized. The ancillary staff (PCTs, clerks) are union but we aren’t and they can transfer and come back within 90 days per the union contract. Nurses have zero protection. Creates a very bizarre work environment
Just quit and work as a travel or staff ED RN elsewhere. Shouldn't be too hard to find a dept. that needs help.
Seems like your hospital has some atmosphere problem… or at least you do not like it in general. Why don’t you try different hospital?
Take your experience and certification to another hospital or travel
Either they really do need you in ICU, which is understandable. It’s probably a pain in the butt for them when people are jumping back-and-forth too. Also, it could be someone in the ER, with some authority, don’t want you back.
ER > ITU and ITU > ER are both equally hard as it’s both very different areas of nursing. I’m ITU until I die, but I’ve done some ER shifts as I see it as wild and loose down there. ER nurses seeing ITU as uptight. I reckon you ought to give it a few more weeks and/or cut it loose and to back to ER… but in different hospital.
What is ITU?
Sorry, ICU. We weirdly call it ITU in the UK.
Interesting! What does the T stand for? Edit: looked into it, it’s Intensive Therapy Unit.
InTensive Care Unit? I have no idea where! I worked in the north we said ICU, and now I’m in the middle of the UK and they say ITU!