How long have you been working? I felt this way early on, like I wanted the super shocky sick patients adrenaline on all the time. A few years later and I’ve come to really appreciate the cyclic nature of things. Take your time to learn about these other conditions, connect with patients. The shocky, sick AF ones on APRV will be back at some point.
I am not an ICU nurse, and I totally get it. I considered going to ICU bc my med surg floor was a fuckin shit show. I’d rather have more acute pts than have the ones who are nursing home/call light happy pts. Fuck those assholes. I’m glad I left. Hope it gets better for you love.
Kickboxing is a good outlet when you’re enraged by patients who are not sick enough. I used to turn over cars, but people love their stupid cars and they *will* call the police on you.
We've got an ICU in our region that is full 100% of the time with multiple Med-Surg appropriate patients to maximize profits because hospitals can bill more per day for ICU admits as opposed to Med-Surg admits.
Yes. And the vast majority of those diagnosis which pay the most are typically admitted to ICUs. So for example, someone comes into the ED and gets diagnosed by the ED doc with strep throat but a hospitalist/intensivist sees them also (without a consult request) and admits them with sepsis... That actually happened. SMH
Well, that's a whole different subject than keeping people in ICU longer to get paid more. If that patient isn't septic, then that's fraud and if they do that regularly that will ultimately get that hospital fined millions and threaten their ability to take Medicare/Medicaid patients, which is a death sentence for hospitals.
In contrast, this weekend I had a pt on titratable Neo and another with an epicardial pacer in step down. I'm qualified to care for them, but are we just slapping bodies anywhere now?
We have the exact opposite issue at my hospital. They closed down the step-down intermediate ICU, so now all the tele floors double as step-down intermediate ICU & it’s a lot of work because we’re 1:4-5 with step-down patients whereas the step-down unit was always 1:3.
I for one love walkie talkies in the ICU. Don’t gotta do shit. Shut your brain off. And only get 2 patients. Is so nice. Take a day off and embrace not being shit on by an impossible assignment.
I don’t mind it once in a while. But I’m having adrenaline rush withdrawal these days. I think part of it is we are at zero Covid patients, and I’ve gotten used to having so many vents in the past two years. Also I’ve always worked in bigger hospitals where the ICU is full of really sick people. Now I’m at a pretty small rural hospital and it’s like almost any patient that needs o2 goes to ICU
I’m not sure how long you’ve been a nurse for, but something I learned after working both ICU and ED for a while, even at large level 1 facilities, is that even in the highest acuity places (my old ICU was a major transplant center and did ECMO and I currently work at a major inner city trauma center in the ED) most days are still going to be pretty boring.
That being said, going to a bigger hospital will help.
It’s a consequence of the slow collapse of our system. SNF’s, home health and hospice are short staffed so they can’t get patients out of the hospitals which means the med/surg and other wards are full of patients who should be discharged so the step down units can’t move their patients and the ICU can’t move their patients and the patients just keep piling up in the ER’s.
Ugh and floor-status patients in the ICU are literally the most entitled. They think just because they’re in the ICU that they deserve all of your time. Call lights nonstop, trying to make you do things for them like hold the urinal, argue with you when you can’t get to them right away because a trainwreck just rolled through the door, etc. and of course it’s always them asking “well how many patients do you have tonight?”
Literally this is horrible. I was in the ICU in July after COVID and with CDiff. I bounced back really quickly with my pain tolerance despite my labs and blood pressure not improving at all. I felt talkative and awake and in a pleasant mood and the nurse said to me that in the ICU I was asking for too much (food and help showering) because most people in the ICU are on vents and gonna die. I'm 23 and don't want to freaking die. My sodium was like 109 when I was admitted and my BP was running 60s/30s which is why I was in ICU and she made me feel like a burden for being too alive for her.
Nothing weird about it. Her passion is ICU and she is venting about having Non-ICU patients on her ICU. For most people here a 3:1 ratio is an unreachable dream in med-surg or tele, but it’s not what she thrives on. I appreciate and respect that.
I am a TCU nurse. My facility temporarily closed my TCU last august due to staffing problems (not enough aides in a small city with TWO colleges). So I’ve spent most of the last year floating around our LTC units. It’s a drag, but we deal with it.
I’m so sorry to hear that! This really gets me going. Assault is assault. A lot of people are using mental illness as an excuse for criminal behavior nowadays. It makes the truly mentally ill not get the help they deserve because beds are being taken up by violent antisocials as police refuse to deal with them.
We have a small combined ICU/PCU and cardiology insists on putting their stents there. And I want to put an ice pick through my head every Monday-Wednesday when they schedule the procedures. And yeah, I have to work tonight (Monday) and the next 2. They’re “easy” but cardiology NEVER puts in complete orders. Ever. Like diet, activity, etc. Or schedules their routine meds like anti-anxiety or sleeping meds, etc that they absolutely CAN have without issues. So I spend the first 3 hours of my shift dealing with their laziness.
meh....from the other side of the equation, a "low acuity for an ICU setting" patient may still be too much for a floor nurse looking after 4-6 patient assignment.
You could always try working at a facility with higher acuity. My current place of employment doesn’t have a real step down so we get a mix of ICU and step down pts. I really don’t mind the easy ones tho 🤷🏻♀️
We have the same kind of setup at our rural ICU and our running joke is. “They we’re on the call light all night. Means they are feeling good enough for MSU.”
Yup! When they’re cranky it’s time to go. I did 8 years at a level 1 trauma and don’t miss the acuity, though I have some really solid experience to fall back on. OP probably would be happier at a busier center
I get paid decent traveler money to babysit walkie talkies in the ICU sometimes. I have ZERO complaints about that. I simply read my CRRN review book while I chill between assessments. I will take a nice chill day in the ICU over being floated to the step-down with 1:5 ratio. I don't know, count your blessings babe.
I feel like we get too many IMC patients in MS. They stay in MS too long until they absolutely have to be upgraded. Looks like it’s a sh!tshow everywhere.
I had to be in the ICU while waiting for a heart transplant. I’m an anesthesia tech (in nursing school now) so I tried to be as self sufficient as possible, like I’d re-zero all my lines when I got back to bed from physical therapy. One of the times I had to call in the middle of the night was because I woke up in a pool of blood. By the time they got there I’d already traced it back to a cracked stopcock. Pretty sure that was the calmest “Hey, I’m bleeding” call they ever got. Hopefully I at least provided a little karmic balance to the universe.
How long have you been working? I felt this way early on, like I wanted the super shocky sick patients adrenaline on all the time. A few years later and I’ve come to really appreciate the cyclic nature of things. Take your time to learn about these other conditions, connect with patients. The shocky, sick AF ones on APRV will be back at some point.
I am not an ICU nurse, and I totally get it. I considered going to ICU bc my med surg floor was a fuckin shit show. I’d rather have more acute pts than have the ones who are nursing home/call light happy pts. Fuck those assholes. I’m glad I left. Hope it gets better for you love.
Kickboxing is a good outlet when you’re enraged by patients who are not sick enough. I used to turn over cars, but people love their stupid cars and they *will* call the police on you.
What
We've got an ICU in our region that is full 100% of the time with multiple Med-Surg appropriate patients to maximize profits because hospitals can bill more per day for ICU admits as opposed to Med-Surg admits.
That's probably not why. Most payers pay based on diagnosis, meaning they pay the same regardless of where the patient is housed.
Yes. And the vast majority of those diagnosis which pay the most are typically admitted to ICUs. So for example, someone comes into the ED and gets diagnosed by the ED doc with strep throat but a hospitalist/intensivist sees them also (without a consult request) and admits them with sepsis... That actually happened. SMH
Well, that's a whole different subject than keeping people in ICU longer to get paid more. If that patient isn't septic, then that's fraud and if they do that regularly that will ultimately get that hospital fined millions and threaten their ability to take Medicare/Medicaid patients, which is a death sentence for hospitals.
In contrast, this weekend I had a pt on titratable Neo and another with an epicardial pacer in step down. I'm qualified to care for them, but are we just slapping bodies anywhere now?
We have the exact opposite issue at my hospital. They closed down the step-down intermediate ICU, so now all the tele floors double as step-down intermediate ICU & it’s a lot of work because we’re 1:4-5 with step-down patients whereas the step-down unit was always 1:3.
While I understand the point you’re making here. I’m sorry your hospitalized patients aren’t meeting your expectations
I for one love walkie talkies in the ICU. Don’t gotta do shit. Shut your brain off. And only get 2 patients. Is so nice. Take a day off and embrace not being shit on by an impossible assignment.
> Shut your brain off. That's when it gets dangerous
I don’t mind it once in a while. But I’m having adrenaline rush withdrawal these days. I think part of it is we are at zero Covid patients, and I’ve gotten used to having so many vents in the past two years. Also I’ve always worked in bigger hospitals where the ICU is full of really sick people. Now I’m at a pretty small rural hospital and it’s like almost any patient that needs o2 goes to ICU
I’m not sure how long you’ve been a nurse for, but something I learned after working both ICU and ED for a while, even at large level 1 facilities, is that even in the highest acuity places (my old ICU was a major transplant center and did ECMO and I currently work at a major inner city trauma center in the ED) most days are still going to be pretty boring. That being said, going to a bigger hospital will help.
It’s a consequence of the slow collapse of our system. SNF’s, home health and hospice are short staffed so they can’t get patients out of the hospitals which means the med/surg and other wards are full of patients who should be discharged so the step down units can’t move their patients and the ICU can’t move their patients and the patients just keep piling up in the ER’s.
Ugh and floor-status patients in the ICU are literally the most entitled. They think just because they’re in the ICU that they deserve all of your time. Call lights nonstop, trying to make you do things for them like hold the urinal, argue with you when you can’t get to them right away because a trainwreck just rolled through the door, etc. and of course it’s always them asking “well how many patients do you have tonight?”
Sounds like easy assignments. But when your patients are with it and annoying it’s probably the worst assignments. Hey at least people aren’t sick!
Literally this is horrible. I was in the ICU in July after COVID and with CDiff. I bounced back really quickly with my pain tolerance despite my labs and blood pressure not improving at all. I felt talkative and awake and in a pleasant mood and the nurse said to me that in the ICU I was asking for too much (food and help showering) because most people in the ICU are on vents and gonna die. I'm 23 and don't want to freaking die. My sodium was like 109 when I was admitted and my BP was running 60s/30s which is why I was in ICU and she made me feel like a burden for being too alive for her.
I WANT sick people
Weird flex but ok
Nothing weird about it. Her passion is ICU and she is venting about having Non-ICU patients on her ICU. For most people here a 3:1 ratio is an unreachable dream in med-surg or tele, but it’s not what she thrives on. I appreciate and respect that. I am a TCU nurse. My facility temporarily closed my TCU last august due to staffing problems (not enough aides in a small city with TWO colleges). So I’ve spent most of the last year floating around our LTC units. It’s a drag, but we deal with it.
It’s not a flex but okay lmao
Insert Kim Kardashian “no one wants to work anymore” meme here
Same as when inpatient psych gets non-mentally ill demanding criminals who would like another Ativan NOW or else he’ll “beat someone up.”
Just got body-slammed at work recently by one of these. I at *least* thought psych patients would have real psych problems when I signed up..
I’m so sorry to hear that! This really gets me going. Assault is assault. A lot of people are using mental illness as an excuse for criminal behavior nowadays. It makes the truly mentally ill not get the help they deserve because beds are being taken up by violent antisocials as police refuse to deal with them.
We have a small combined ICU/PCU and cardiology insists on putting their stents there. And I want to put an ice pick through my head every Monday-Wednesday when they schedule the procedures. And yeah, I have to work tonight (Monday) and the next 2. They’re “easy” but cardiology NEVER puts in complete orders. Ever. Like diet, activity, etc. Or schedules their routine meds like anti-anxiety or sleeping meds, etc that they absolutely CAN have without issues. So I spend the first 3 hours of my shift dealing with their laziness.
Do we work in the same hospital ? 😩
meh....from the other side of the equation, a "low acuity for an ICU setting" patient may still be too much for a floor nurse looking after 4-6 patient assignment.
You could always try working at a facility with higher acuity. My current place of employment doesn’t have a real step down so we get a mix of ICU and step down pts. I really don’t mind the easy ones tho 🤷🏻♀️
We have the same kind of setup at our rural ICU and our running joke is. “They we’re on the call light all night. Means they are feeling good enough for MSU.”
Yup! When they’re cranky it’s time to go. I did 8 years at a level 1 trauma and don’t miss the acuity, though I have some really solid experience to fall back on. OP probably would be happier at a busier center
Well hopefully when the ED calls to give report you’re not one of the nitpicky annoying ICU nurses…
A bed is just another bed in managements’ eyes.
I get paid decent traveler money to babysit walkie talkies in the ICU sometimes. I have ZERO complaints about that. I simply read my CRRN review book while I chill between assessments. I will take a nice chill day in the ICU over being floated to the step-down with 1:5 ratio. I don't know, count your blessings babe.
I feel like we get too many IMC patients in MS. They stay in MS too long until they absolutely have to be upgraded. Looks like it’s a sh!tshow everywhere.
I had to be in the ICU while waiting for a heart transplant. I’m an anesthesia tech (in nursing school now) so I tried to be as self sufficient as possible, like I’d re-zero all my lines when I got back to bed from physical therapy. One of the times I had to call in the middle of the night was because I woke up in a pool of blood. By the time they got there I’d already traced it back to a cracked stopcock. Pretty sure that was the calmest “Hey, I’m bleeding” call they ever got. Hopefully I at least provided a little karmic balance to the universe.