[The unexplainable Moo Cow]

I came off my shift at 0730 this morning and walked over to the MICU to shadow a RN there for a couple hours. Not much happening there for the 3 hours I managed to stay awake for but I know they have their moments. Just a couple thoughts on ICU vs. "floor" nursing.

1. Thoroughness with the pt. in caring, charting, reporting, and all around knowledge of the pt and their condition
2. More monitors and frequent monitoring. Different equipment and set up. All equipment is readily available in the room.
3. Interdisciplinary teams at your disposal.
4. Medical ICU takes overflow of CICU, SICU, CVICU. Train wrecks include bed 1 with COPD exacerbation and DKA and bed 2 with gunshot wounds with every hocus-pocus med drip available to keep him alive. And oh yeah, there is someone outside the hospital to visit him and finish him off.
5. ICU RN to leave the unit to attend to a code on the medical-surgical floors; but usually for no more than 30 minutes
6. Nursing diagnosis are actually used

ICU nursing is an all around different animal.

My issue with "floor" nursing is my inability to be thorough with my pts. I find myself fighting against the clock to assess, medicate, treat, teach, fill orders and provide psycho/social support to my pts, even if I'm assigned only 4 of them. Perhaps I'll get better at it someday or maybe not.

I have yet to make appointments with the other ICU units in the hospital I'm employed at and see what they are like as well.

Anyone else have thoughts related to ICU nursing and how it may be different from "floor" nursing? Or perhaps what is it about floor nursing that makes the ICU unattractive?

[Ashley Anne]

I was just wondering what exactly MICU is....I am an LVN student right now. I will definately go on to get my RN. I've heard that ICU is a great place not only to work but to learn as well..

[The unexplainable Moo Cow]

Originally Posted by Ashley Anne

I was just wondering what exactly MICU is....I am an LVN student right now. I will definately go on to get my RN. I've heard that ICU is a great place not only to work but to learn as well..

MICU = Medical intensive care unit
CICU = Cardiac intensive care unit
SICU = Surgical intensive care unit
CVICU = Cardiovascular intensive care unit
NICU = Neonatal intensive care unit

I'm sure there are others but these are the ones I know.

[cougarnurse]

How now, Cow?! I give ya credit for the ICU bit. I work LTC, and try to spend time with every resident...or at least the ones who are pretty decent. We have one or two (maybe three) who are NOT happy campers....

"Cat"

[MagRedC5]

I admire those that do Floor Nursing with how well they manage their time with patient assignments up & down the hall. I've done the Tele Flr, OR, and ICU. This past summer I did an intense 14 week critical care nursing course via the Army Medical Department at Madigan Army Medical Center. Now, my military nursing specialty designation is critical care nursing and I would have it no other way.

[The unexplainable Moo Cow]

Originally Posted by cougarnurse

How now, Cow?! I give ya credit for the ICU bit. I work LTC, and try to spend time with every resident...or at least the ones who are pretty decent. We have one or two (maybe three) who are NOT happy campers....

"Cat"

I'm becoming unhappy with floor nursing more and more. I do not have a charge to bring against anyone I work with or management. The problem is a lack of staffing. When I come on at 1900 and I'm assigned 5-6 pts, then I know it will be a horrible night. Because at 2300 when afternoon RNs go home I'm taking an additional 1-3 pts which is dangerous on a tele floor. Plus we have to deal with new admissions.

I was told that ICUs have issues as well. The MICU RNs once in a while will take on 3 pts, which is not good. In CICU, they sometimes have low census and it is highly competitive - good luck trying to work OT.

Anyone here work at a well staffed hospital? What is an ideal RN/pt ratio?

[Ricu]

Originally Posted by The unexplainable Moo Cow

I'm becoming unhappy with floor nursing more and more. I do not have a charge to bring against anyone I work with or management. The problem is a lack of staffing. When I come on at 1900 and I'm assigned 5-6 pts, then I know it will be a horrible night. Because at 2300 when afternoon RNs go home I'm taking an additional 1-3 pts which is dangerous on a tele floor. Plus we have to deal with new admissions.

I was told that ICUs have issues as well. The MICU RNs once in a while will take on 3 pts, which is not good. In CICU, they sometimes have low census and it is highly competitive - good luck trying to work OT.

Anyone here work at a well staffed hospital? What is an ideal RN/pt ratio?

Hey Moo,

I think the list you made when you did your ICU observation is very accurate in summary form. I'd like to elaborate a little on the nurse's role especially when it comes to the patient assessment. In order to utilize those component parts well ie; monitors, interdisciplinary team players, etc., the nurse's assessment must always be constant. It is our job to catch those subtle changes and react to them in order to ensure the patient is progressing toward wellness. This is where those protocols streamline the proceess and the ICU nurse is in the middle orchestrating the process. I think this dovetails into your question about nurse/patient ratio. Generally the ICU ratio is 1:2 but realistically should reflect acuity and not census. I've taken 3 and even 4 patients in the unit but these are patients whose acuity has been downgraded to tele or floor status and are awaiting transfer. At other times, I've had a single patient who's a cardiac trainwreck on IABP, drips, ventilator and waiting for or is just out of a CABG. To summarize my own position while concurring, I think, with your hypothesis, I would be hard pressed to work the floor again because it really isn't my kind of nursing that happens out there. I believe it is assembly line "cursory" care; vitals, meds, printed education material, bye. I've worked the floor and it was like that or worse. In the unit, it can be crazy there too, but it's more gratifying than the floors-for me, anyway. Keep up the search.

R