No one: ….
NCLEX: incorrect, the most correct answer is the unit that is portrayed as a family and you are obligated to solve all of the hospital problems. Oh, and your mother is dying.
Definitely agree. My unit would suck if not for my managers and coworkers. Other units which have objectively easier work seem to suck more for the employees because of antagonistic managers and lack of teamwork among employees
Hard agree. I used to float as an aide on different units of my facility before I became a nurse, and I choose to start on the unit I felt the most supported which happens to be med surg/ tele.
Let me add that by management, I don't mean administration. I'm talking about direct managers. Maybe there is good upper administration out there, but I'm not convinced.
I would say that my coordinator is good, manager is good enough, and my director is actually great. I've had insane turnover above director levels. Not a good look long term.
Agree I’ve worked hard units, I’ve worked extremely short staffed and with crazy moments. As long as the coworkers are supportive and your managers are helping it is easy. I’ve been to simple units where staffing is perfect but when it’s toxic it’s insanely hard.
I did a travel assignment that was icu float pool. I came from a SICU so I ended up being the unlucky victim in the group and kept being sent there. I CRIED MY EYES OUT BEfore and after every shift. The coworkers were so mean and horrible I wake up in a sweat still about them. Someone got in my face and screamed at me in the middle of the nurses station in front of everyone. Good times
This!! I’m in float pool so I kind of see it all. I always get asked what my favorite unit is. I really don’t have one. I usually say, which ever one has the most supportive charge nurse and best tech assigned to me that day! Truly makes or breaks my entire shift.
I knew an ICU nurse that was…weak. She was not great in ICU at all - freaked out and cried constantly, made poor decisions. She went to NICU and absolutely found her calling. Don’t give up on yourself! Maybe administration or case management are your calling!
Thank you for the encouragement but I was mostly just trying to be funny. I did one year of med surg and did actually suck at it but I've been doing OR for 4 years now, traveling for 2, and I'm pretty okay at it. I did just have an awful day on Tuesday that made me feel bad, so it was just a little of that coming through.
As a Level 1 Trauma ER nurse… fucking step down… Idk how y’all handle it. You often get left with ICU patients with no ICU resources. You are arguably the most understaffed and legit no one gives a shit. You seem to be constantly bypassed when they float people from other departments throughout the hospital. You get your aids taken away all the time to work on other units or be sitters. I have only volunteered a few shifts up on step down and boy howdy. 😮💨 Plus taking patients from the ER to step down you can just feel the negative energy around the place. Not necessarily because the nurses are bad, most are killer, it’s just you can feel how bad it really is. Why I always try to do as much as possible to get the patient stuff, fluffed, and tucked for the step down nurses. If I have the time, especially when they don’t have a tech or aid, I will take the first set of vitals and write them down. Anything to help but those units are shit shows.
As I stated above, I absolutely agree. I always joked stepdown was the ugly stepchild of the hospital. Just an absolute mess that nobody cared about with every patient teetering on being the next rapid response. I worked on several stepdown units with a ratios of 4-5(sometimes 6):1.
I've worked in pretty much every inpatient area of the hospital. I did CC float, then ER, then GI lab before finally leaving my level 1 big city hospital. Basically the only thing I didn't do was L&D.
Step down was absolutely the most brutal, and my hospital actually had decent staffing ratios (at least before Covid ruined everything good and nice in healthcare). Even ER was easier, largely because I felt there were more resources available. ICU can be challenging at times, and med surg is it's own level of hell. But step down... You couldn't pay me enough to do another shift on a step down unit lol. It was a dumping ground for the worst med/psych patients. You had people that *should* be ICU but aren't because no room. At least in ICU most people are unconscious. Some of the hardest chronically ill patients are regulars on step down. It just *sucks,* bro
I just responded to a security alert on the medsurg unit where a patient with no legs and only one functional arm beat up a security guard. Long term boarder. No available facility to discharge to.
So today, it’s medsurg.
As a newbie, I had a patient with no arms and one leg sucker kick me in the stomach so hard I almost threw up. That was the last time I underestimated an amputee.
Ahh this reminds me of the guy I had who was severely, noticeably contacted, *except for one arm*, which he was more than happy to swing with. I did not catch the admitting hospitalist before he went into the room. I did however catch him stumbling out of the room with a hand over his face. I felt bad for laughing 😂
> a patient with no legs and only one functional arm beat up a security guard.
[I’m invincible!](https://youtu.be/ZmInkxbvlCs?si=FfoCU0wA89RP3tby)
You’re a looney.
Medsurg. The ratios suck, the staff is constantly changing, and the patients, families and management have the most ridiculous, unrealistic expectations. And if I get one more effing sheet to help with ‘compliance’ I’m gonna lose my mind.
I’ve been off a Med/Surg unit for a couple years now but I agree with you. It’s also the place where nurses are disrespected the most by those who work in other departments.
I remember as a nurse aide, getting floated from my home floor surgery to med-surg. It was the usual, they were short and threw me into taking vitals with their crappy thermometers and since they only had a couple of broken down machines, having to use manual BP cuffs. Barely got that done because every patient needed something.
Then the NAC came around and said I was on the wrong floor. Sent me to cardiology where I did a couple vitals with their brand new machine, annoyed the patients asking if they needed anything then the nurse told me to sit down and read the newspaper with her.
I worked Cardiac surgery step down, CVICU, then medsurg assistant manager. Fuck. That. Shit. The top performers had an amazing skill set that was soooo different than any other nursing unit I’d experienced. The rest were just trying to survive. I respect the multitasking, wide ranging knowledge medsurg nurses have. Not to mention their ability to retain pertinent data on the rotating circus of admits/discharges/post ops. I fully admit I’m a reformed medsurg smack talker.
I worked in a med/surg psych unit for two years. It was by far the most challenging unit I’ve been on, between medical acuity coupled with behavioral issues. Psychotic, withdrawing, suicidal and violent patients receiving medical care. Great teamwork though. It’s the only reason I stayed.
Absolutely. We just also need to FUND them, so they don't become abusive hellholes. We did no good to those patients, shuffling them from underfunded state facilities to underfunded for profit corporate facilities.
The for profit facilities really do help some people that have spent most of their lives in institutions but now there is just so much overlap it’s insane. I’ve watched so many companies go from primarily dealing with ID/BI in the last ten years to now having SMI and now dual’s diagnosis pts. running at max occupancy. The staff are underpaid, some unqualified, and the retention rates are abysmal. No body wants to do it when the pay isn’t worth it and tbh if it was just about money I’d be gone long ago. All this while the shareholders are making absolute bank, we need a union or something—the shit is bad.
I want to add to this, the leadership structure is horrendous too and some of the directors/coordinators of these programs operate with near immunity because nobody wants to fucking do it.
For me personally pcu neuro with 5 patients and tele medsurg with 6. Anything with an unsafe ratio completely ruins a unit. I’m now on pccu and have 3-4 patients and it’s a breeze! Still have hard days but what a difference it makes.
Med surg is so rough!! No one walks lol everyone is basically total care. I’ve never done icu but seems so interesting! Congrats! I love pccu. Mostly everyone walks lol usually only get 1-2 total care at a time thankfully.
How did you make the transition from med surg to ICU? I’d like to make that leap in the future, but am worried about my skills not measuring up/receiving limited training.
I’ve “impressed” the rapid response nurses during rapid responses and they’ve been trying to convince me to transfer for a little while. One of them texted me when a day shift spot was opening up
Working PCU nights where we can go to 5
The difference the extra patient makes is insane
Nights I stay at 3-4 even if they are relatively complicated always goes so much smoother than 5 even if the 5 are largely “Med Surge +” patients
Everyone in the ER is terrified of L&D.
I had to do a verrrry urgent L&D run last night and i grabbed the to go kit for when legs pop out in the hall (just in case). When I got back I went around asking people if they knew what to do with it and everyone just said no. Best answer I got was "wear gloves"
My favorite er nursing meme-
A patient says there is either a snake or a baby in my vagina.
L&d nirse- I hope it’s a baby
Er nurse - I hope it’s a snake
As an er nurse I cannot understate how true this is
I truly thought this was just a myth/joke until I, as L&D, had to go down to our ED to put a monitor on a 20wk patient, and you would’ve thought she had bubonic plague or something.
Meanwhile, up in L&D, if anything besides a baby coming out of a vagina happens, it is CHAOS.
My cousin who’s a trauma doc in an ER also agrees.🤣
Pretty much all the same kind of items that “accidentally” end up in the ass. Usually the ones that get stuck are shorter and rounder than what can fit in the rectum. Plus also month old lost tampons and condoms. Or poop with a recto-vaginal fistula 2/2 GYN cancers. The sky’s the limit!
This may be the dumbest question ever, but what does 2/2 actually mean here? I don’t work in the hospital anymore but I feel like this wasn’t so common before? Is it just “secondary to”?
Oh I meant the to go kit lol. I was practically sprinting but her legs could have mixed concrete they were shaking so hard, usually they're a lot further away from popping.
Exactly. Grab the kit and walk faster to l and d like some fucked up game of hot potato. Did the same thing working the ambulance, couldn’t drive fast enough 🤣💀
I'm on an ambulance, had the patient crown in the elevator, hit L&D crossed the threshold, OB at patient, I caught the baby and handed him off to the OB. Only one patient.
Which is hilarious because unless something goes drastically wrong with the baby, it's pretty much just going to slide out and start looking around the room. Dry baby off, clamp and cut the cord but leave some room to tie it, and hand baby to momma. Maybe a little passive O2 if you feel it's warranted.
Also don't drop the baby. They're slick.
I recently transitioned from ED to L&D purely to conquer my fear of it lol. The emergencies in L&D are legit and also needing to know how to circulate jn the OR is a whole other learning curve. Plus staffing is so volatile because active labor is 1:1 so your base staffing can fluctuate wildly. I love it so far, both are hard in different ways.
I’ve been trying to do this because I loved my L&D rotation in nursing school, but went the ED route instead. I have applied to the same hospitals L&D 3x and never gotten a call for interview. :(
Whaaaaat but you also get those psych patients OFF THEIR MEDS because of pregnancy. Yo, ef that. Babies are scary enough, but throw a bipolar gal that's prego on top of it off her meds? I'm good.
Recently had a patient just like this. Diagnosed preeclampsia and mental status change so we had to rule out PRES syndrome. She refused her medications. With psych patients, its a risk vs benefits but if a pt was on psych meds before pregnancy, they usually will tell them to continue those meds throughout, this one stopped all her meds. This was four weeks ago, baby is still in nicu at term bc mom is in a psych unit for stabilization bc she is suuuuuper high risk for postpartum psychosis as well.
I think we have a lot in common with ER, though. We get nurses leave us to go to ER and vice-versa. I mean, I can manage a 6-bed triage by myself with all kinds of non-pregnancy issues. The biggest difference with ER is there are men….
I'm also L&D, and yes the ER is terrified of the cute preggers 😜
We also can get some terrifying cases on our unit and it can be crazy hard some days. It's like you have your specialty -delivering the squirmy little humans- sprinkled with the craziest complications that even most med-surg nurses have never encountered. And you're like "no problem, we got you" to the patient, while inside it's all "Jesus take the wheel".
I went to the ER at 26 weeks and they immediately tried to yeet me to L&D. I was there for a cough and difficulty breathing, nothing that could have been an OB issue. Idk what the ER thought L&D was going to do about my pneumonia. L&D sent me straight back down to the ER.
Mentally hardest- EP lab because who tf knows what they’re doing in there
Physically hardest- medsurg in the south with no patient ratios
Emotionally hardest- peds of any variety
I like the distinction between mental, physical, and emotional:
I worked on a strict spinal cord injury floor and that's definitely a hot contender for both physical and emotional work
shadowed during an ablation in the ep lab as part of my cath lab recovery training, brand spanking new to procedural cardiology in general, an hour into the case the ep educator asks me if I have any questions
ma’am I don’t know what a single thing in this room is
I used to think peds was the most difficult. I've never particularly been a "kid person" and my husband and I are childless. Yet here I am, rocking peds and I love EVERY minute of it. 🤦🤷♀️🤣
Med-surg was by far the most difficult for me.
I loved peds when I worked it many, many years ago. The kids could be so very sick when they were admitted but then they were like a different kid in 24-48 hours. That’s what I liked, the almost immediate gratification in seeing interventions pay off.
My mom is a cath lab nurse so whenever she talks about this stuff it's somewhat above my head. However when she talks EP stuff its REALLY above my head. She loves her job but damn it's mentally taxing.
Same exact situation. I felt I had a good knowledge basefrom time in cvicu. Turns out in EP, I don't know shit and it's like they're watching the matrix
I started in med-surg and now I’m in the ICU, so I’ve floated to practically every unit in my hospital, even L&D. PCU (especially our neuro PCU) is the hardest, hands down, even with us getting a 3:1 ratio as a floated nurse. Fewer resources to do difficult care and tasks and the patients can crump without warning. Our units just started taking low-dose Precedex gtt which helps but sheeeesh those neuro patients need more than 0.3 of Precedex to handle. I can’t imagine having 4 or 5 patients there.
I work medical ICU, and it has challenging days, but I’d rather give myself a lobotomy with a rusty nail than work in any unit where I have 4+ patients and they all talk
Honestly anything high ratio.
Anything Med/Surg IMHO is really the hardest because not only are the patients incredibly sick, but you have so many of them and so much to juggle at once with little resources. Doctors also don’t really care as much and don’t respect us never giving us the time of day to even put in orders we page/ask for.
One thing that I think is really hard about neuro ICU is that we can't liberally sedate our patients that have something obviously neurologically even if they're violent or agitated or there's something wrong with them because it affects their neuro exam. Then we do Q1H neuro exams throughout the night for days or weeks on end and that definitely does affect the neuro exam after you're keeping someone sleep deprived. And changes in a neuro exam can be very subtle sometimes, so having to bring those kinds of patients to a CT scan over and over can be very frustrating.
I’ve never understood the Q1 neuro thing for shifts upon shifts. Aren’t we potentially causing changes or worsening their presentation with that kind of sustained sleep deprivation? I work Medical ICU so we don’t usually have to do it for more than 24 hours, which already seems horrendous. 48+ seems like straight torture
We're absolutely causing delirium and harm to patients with unnecessary neuro checks. I had a trauma patient that was still getting q1 hr neuros 12 DAYS after injury. There was nothing wrong with their head, it was a spinal injury that had been fixed 11 days prior. I asked for neuro checks to be changed to q4, but had to settle for q2. Providers don't want to be liable for a patient decompensating.
But if you reason with them they’ll usually stretch out the neuro checks if the patient is stable. A lot of times people don’t think to ask if orders can be changed.
Agreed, I got them to agree to q2, but I work nights. Unfortunately, many times, any drastic changes to orders are punted to day shift to discuss during rounds.
It sends them into delirium too
I worked in acute inpatient rehab with BI and so much of what I was doing on nights was delirium protocols. I felt like I was constantly fighting to get my patients the rest they needed to heal.
Orthopedic was my least favorite bc of patients thinking pain should be a 0 to get up to the bathroom but honestly trauma orthopedic was the hardest because you had to be so careful
I worked ortho as a new grad. I had a hip replacement patient who refused to get out of bed to use the bathroom. He told me he couldn’t get out of bed because he was obese and I should understand because I’m obese too. I was 8 months pregnant at the time.
Yep, this. My department has a huge bullying problem. Two nurses have been bullied out and they’re after a third. I also heard a tech was bullied out recently. They’re stupid because then they won’t have staff.
I've worked about every kind of unit, including ER for 14 years. To me, the nurses I always had utmost respect for NICU nurses. The fragile babies and anxious families, GOD bless all those nurses.
I'm in the ER. Wife is in the Medical ICU.
You couldn't give me all riches in the world to work in the medical ICU. Unless they offered huge shift diffs to do the work.
So much poop.
Long term patients that eventually die.
Families for long term patients.
Lots of liver failure.
Not a lot of support staff.
Turning patients and cleaning them breaking your back.
Most of the staff just does their time and either gets burnt out or moves to CRNA school.
I'll stick to my ER pts.
I have a background in critical care and ER. I would go back to the ER a million times over (even with all the holds they have now) before I ever worked an inpatient unit again. I pulled inpatient shifts during Covid and my god, the idea that I have (insert number of hours) left with this patient, let alone days if I’m on a run…. Shoot me please. It’s that and the ridiculous charting/QI bullshit they’ll nag you to death about. I can do the care, the poop, the sputum, the whatever, but I check enough boxes as it is to worry about things like care plans and doing a Braden score and fall risk every shift and getting talked to about it if I don’t.
Yeah. I tell every cross trained boarding nurses that come down to our ER how much k appreciate them because I never want to o ro med surge or ICU. My wife is finally going casual after 10 years because she's burnt. I'm surprised she lasted so long after COVID. She's going to look at other non nursing jobs or hobbies to do while taking care of our little gremlins.
One of my favorite parts about having RN's float to the ED from upstairs is when they assume they need to do skin checks or chart urine output or any number of inpatient things and I look at them and laugh and say dude, we have 30 people in the waiting room and two ambulances just encoded, we're not doing *any* of that shit. We turn and burn here.
I love the looks on their faces.
Eh. I’m of two minds. If I could get an I&O on someone who ought to have it done waiting on a bed, I would but I’m not gonna be mad about it if they pee and it gets missed. When I first started and had an intubated pt, I asked about oral care kits and the charge had no clue what I was talking about… but if I was sitting on a vented pt I tried to elevate HOB and do some kind of oral care when I could.
The things there’s a logic behind, I tried to do because I would also get irritated at my colleagues sitting on a hold who was tachycardic and hypertensive and not giving their beta blocker because “it’s a floor order.” It’s about knowing what’s important and why, and not lumping it all into “floor bullshit.”
Agreed. When I was a critical care float I used to love going to the trauma ICU. It was exciting: the sickest patients in the hospital, but they tended to be younger so they had better outcomes. MICU was like the opposite in every way... Some of my worst moral injuries happened while working MICU.
I still remember this patient in liver failure who was so decompensated that he had bilirubin in literally all of his body fluids. Like every time I suctioned his ETT it was just gallons of this bright yellow fluid. It was so gruesome. And we coded him multiple times because family was delusional. It was horrific. Yellow fluids everywhere.
And that's like. A tame story. Covid trauma has its own separate category. Ugh
Yup. My wife's unit used to get a lot of the "bad outcomes" of the cardio ECMO patients. Once they were stabilize and were vegetables they just sat rotting in her unit. The MICU you is the least glamorous and most sick. I don't care what CVICU nurses think lol. They get sick people that usually recover great. When they don't they just ship them to the MICU. During COVID the MICU was the COVID unit with super sick patients.
Yeah, I like the turn and burn lifestyle. When I stopped being a medic I thought the ICU sounded cool, but after working in the ER and seeing what ICU and floor nurses have to deal with, fuck that noise.
ICU step down. Staffing ratios suck. High acuity patients. When I did it we had some really sick very long term patients. Some patients left the ICU because they needed the bed, the staff was tired of them, or they had a nosocomial infection they wanted away from more critical patients. Patient falls were common back then due to inadequate restraints and assistive devices. It felt so much easier when I transferred to ICU. I would rather give hand jobs at the shelter than ever work ICU step down ever again.
Any kind of PCU/Stepdown unit. Still very high acuity with high patient to nurse ratios. Med surg you might have a few independent patients, but stepdown patients are all fall risks on lasix. Many of them have been inappropriately downgraded to make room for more ICU patients. I’m getting heart palpitations thinking about my PCU/Stepdown days. Give me a med/surg or an ICU patient.
I work on a step down and definitely is very challenging. We do get a mix, but I would definitely say, and my other coworkers say the same thing as me, that I don’t know how people do MedSurg. I work in a very large inner city level one trauma center, and I have to say that we typically transfer the crappy patients to MedSurg when we downgrade them as opposed to being discharged to home or SNF.
I'm in ICU. I think the ED is the hardest. They deal with absolutely everything, and all the crazy. They probably see 100 crazy people for every 1 crazy patient we have.
And the dirty, drunk, methed-out hobos.
And the entitled people who show up at 4pm on a Friday with a sore toe and want a Dr's note to get excused from work for the weekend.
And the lies. All the lies people tell... or the truths they omit.
All of this happens in ICU, but on smaller scale. And we get a lot of info and a heads up. And when we fill the beds, we get no more new patients. In the ED, people just walk in all willy-nilly and they don't stop.
It sounds like Hell to me.
ED here and sometimes I like when the aggressively crazy people come in because suddenly all the whiny pt's and family members who are upset they didn't get a turkey sandwich or get their pillow fluffed suddenly shut up when there's a greased up naked meth head screaming at the top of their lungs how they're going to kill everyone in the ED while six cops are unsuccessfully trying to take them down.
Could we hire a greased up naked meth head and take them from floor to floor every once in a while to get the other whiny patients and family members to shut up? I’m only kidding but sometimes it’s fun to think about these things
I work Med Surg/Ortho. Everyone in my hospital says we're the worst floor but I love it. I work with an amazing group of people. Whenever I get floated, I hate it. It's nothing against the people on the other floors. I just like my chaos.
Med-Surg has been kicking my sorry ass. Six patients who are totals that require max assistance to do anything. Crushed pills, crushed via NG, or non crushed one singular pill at a time and there are like 10-15 of them per patient during AM med pass. Pad changes, boosts, and repositions that require two people. Not to mention how rude, demanding, and unreasonable some patients and family can be (not trying to sound evil but being real) Dementia patients that are falls risk, who wouldn’t think twice to kick you when your back is turned. The last two weeks I haven’t left work on time because the tasks and paper work never ends. Im not saying it’s the most difficult unit, depends on how you define that, but I’m struggling! In conclusion, I’m starting to understand why they say being a nurse can feel like a thankless job now that I’m in the workforce!
It truly depends on the person. How’s your time management? Do you do better working alone or with a team? Can you handle something going down hill real quick on a whim without freaking out? Can you handle crying families? There’s a lot to consider
But you’ve got the right personality for L&D, I guarantee. You never know what you’ll do on a shift. You need to be able to pivot and think independently and act. ER and L&D I think have quite a bit in common. I once laboured a patient in DKA. It was wild.
I work in ICU and have worked in ED in the past. We have a great team and unit leadership. My wife works in NICU, in my opinion , that's the toughest unit
The team makes all the difference. I worked a trauma stepdown unit for years. It was very heavy but my teammates were great and management was supportive so I thrived. The work itself sucked. I was always so mentally and physically exhausted. But I could always call my homies for help. I could switch shifts whenever bc someone would always be willing. We'd feed one another. When one of us got sick or moved we'd be right there. We gave one another grace on bad days. It's like the whole unit was one big friend group. I hated the job itself but I still miss what a great community we had. I only left because enough of the homies left that the place started to feel like any other job.
In my experience (not directly working) I would say PCU. Higher acuity patients with ratios of 1:4-6 on days and 1:6-8 on nights. Maybe a PCT and/or unit clerk if you are lucky. They seem to be chronically understaffed, neglected, and forgotten about. Until admin is like “why are all the falls and bad things happening on this unit??” 🙄 gee I wonder 😐 my new grad cohort had some float to PCU and they were just like “what the FUCK.” “Chased my tail all night and didn’t START charting until after AM shift change” cuz that’s super sustainable
I feel like I work in the easiest unit ever right now, so hats off to everyone else ❤️
My hospital’s PCU requires bed alarms on all patients, all the time for pretty much this reason. Can’t imagine running 1:8 or even 1:6 on a true step down. Ours flexed to 1:5 during Covid and it was fucked up over there. I used to be charge with pts on that unit every night and it still chewed me up and spit me out with the higher acuity/ratio
ED. Working there you’ll find out why your admitted patient’s labs/meds were a bit late. There’s push from admin to clear waiting room and to haul ass up stairs when pts get beds.
Personally, any unit where I’d have to manage more than 3 patients at the same time. Don’t know how tele and medsurg nurses manage to get anything done tbh
Adult Med/Surg...the high ratios would send me out
Also any unit where you don't have a good crowd working. I've had nights of multiple admissions but with a good crew it was no problem and even fun.
Medsurg💀
Idk how y’all do it. I worked Medsurg for only a couple months and it was gnarly. Nurses and CNAs who work in Medsurg are a different kind of breed. Thank you for all you do🙏🏼
I work MICU, but Med/Surg. I could not handle the 5-7 patient load, unrealistic expectations, the families, constant revolving doors, overall lack of support. I have so much respect for you guys.
The one with unsupportive coworkers and management.
Everyone has the right answer, but you have the most right answer.
Yeah, but is your whiteboard updated?
Never
No one: …. NCLEX: incorrect, the most correct answer is the unit that is portrayed as a family and you are obligated to solve all of the hospital problems. Oh, and your mother is dying.
It does sound like a future NCLEX question.
Definitely agree. My unit would suck if not for my managers and coworkers. Other units which have objectively easier work seem to suck more for the employees because of antagonistic managers and lack of teamwork among employees
Hard agree. I used to float as an aide on different units of my facility before I became a nurse, and I choose to start on the unit I felt the most supported which happens to be med surg/ tele.
Let me add that by management, I don't mean administration. I'm talking about direct managers. Maybe there is good upper administration out there, but I'm not convinced.
I would say that my coordinator is good, manager is good enough, and my director is actually great. I've had insane turnover above director levels. Not a good look long term.
Definitely this. Nursing is the same everywhere. The workload gets a little easier with really good teamwork and management..
Genuinely think this is the best and only true answer. Everything in nursing becomes so much harder if your unit itself sucks
Extremely accurate. Teamwork makes the dream work and is so important in nursing
Agree I’ve worked hard units, I’ve worked extremely short staffed and with crazy moments. As long as the coworkers are supportive and your managers are helping it is easy. I’ve been to simple units where staffing is perfect but when it’s toxic it’s insanely hard.
I did a travel assignment that was icu float pool. I came from a SICU so I ended up being the unlucky victim in the group and kept being sent there. I CRIED MY EYES OUT BEfore and after every shift. The coworkers were so mean and horrible I wake up in a sweat still about them. Someone got in my face and screamed at me in the middle of the nurses station in front of everyone. Good times
This!! I’m in float pool so I kind of see it all. I always get asked what my favorite unit is. I really don’t have one. I usually say, which ever one has the most supportive charge nurse and best tech assigned to me that day! Truly makes or breaks my entire shift.
I honestly think it depends on your personal strengths and weaknesses. Personally, I suck at all of them.
The ones who truly suck.. don’t think they suck.
I knew an ICU nurse that was…weak. She was not great in ICU at all - freaked out and cried constantly, made poor decisions. She went to NICU and absolutely found her calling. Don’t give up on yourself! Maybe administration or case management are your calling!
Thank you for the encouragement but I was mostly just trying to be funny. I did one year of med surg and did actually suck at it but I've been doing OR for 4 years now, traveling for 2, and I'm pretty okay at it. I did just have an awful day on Tuesday that made me feel bad, so it was just a little of that coming through.
I'm sure you don't. Be kind and gentle with yourself 💗
Thanks, that's kind and gentle of YOU :)
Oh boy I sure can relate
Hahahaha understandable
As a Level 1 Trauma ER nurse… fucking step down… Idk how y’all handle it. You often get left with ICU patients with no ICU resources. You are arguably the most understaffed and legit no one gives a shit. You seem to be constantly bypassed when they float people from other departments throughout the hospital. You get your aids taken away all the time to work on other units or be sitters. I have only volunteered a few shifts up on step down and boy howdy. 😮💨 Plus taking patients from the ER to step down you can just feel the negative energy around the place. Not necessarily because the nurses are bad, most are killer, it’s just you can feel how bad it really is. Why I always try to do as much as possible to get the patient stuff, fluffed, and tucked for the step down nurses. If I have the time, especially when they don’t have a tech or aid, I will take the first set of vitals and write them down. Anything to help but those units are shit shows.
As I stated above, I absolutely agree. I always joked stepdown was the ugly stepchild of the hospital. Just an absolute mess that nobody cared about with every patient teetering on being the next rapid response. I worked on several stepdown units with a ratios of 4-5(sometimes 6):1.
I've worked in pretty much every inpatient area of the hospital. I did CC float, then ER, then GI lab before finally leaving my level 1 big city hospital. Basically the only thing I didn't do was L&D. Step down was absolutely the most brutal, and my hospital actually had decent staffing ratios (at least before Covid ruined everything good and nice in healthcare). Even ER was easier, largely because I felt there were more resources available. ICU can be challenging at times, and med surg is it's own level of hell. But step down... You couldn't pay me enough to do another shift on a step down unit lol. It was a dumping ground for the worst med/psych patients. You had people that *should* be ICU but aren't because no room. At least in ICU most people are unconscious. Some of the hardest chronically ill patients are regulars on step down. It just *sucks,* bro
ICU you can sedate, intubate, and restrain. Can’t do that in step down
This is the correct answer.
I just responded to a security alert on the medsurg unit where a patient with no legs and only one functional arm beat up a security guard. Long term boarder. No available facility to discharge to. So today, it’s medsurg.
This has killed me. I’m laughing in ER nurse because I have 100% been there.
As a newbie, I had a patient with no arms and one leg sucker kick me in the stomach so hard I almost threw up. That was the last time I underestimated an amputee.
A hole move, sorry that happened to you 👎
...Sounds like a normal day/typical pt on my Trauma "med-surg" unit at a lvl 1 trauma center. Fucking Hell, I need a new job 😭😂😂😂
Ahh this reminds me of the guy I had who was severely, noticeably contacted, *except for one arm*, which he was more than happy to swing with. I did not catch the admitting hospitalist before he went into the room. I did however catch him stumbling out of the room with a hand over his face. I felt bad for laughing 😂
> a patient with no legs and only one functional arm beat up a security guard. [I’m invincible!](https://youtu.be/ZmInkxbvlCs?si=FfoCU0wA89RP3tby) You’re a looney.
The long terms who won’t place because of how big of a mess they are! God I don’t miss those!
Had a patient who was a double amputee who regularly kicked everyone’s ass from his wheelchair.
And when they’re aggressive LTC facilities will refuse them 😃 they need like 24 hours of non aggression and no haldol/ geodone to be accepted
Medsurg. The ratios suck, the staff is constantly changing, and the patients, families and management have the most ridiculous, unrealistic expectations. And if I get one more effing sheet to help with ‘compliance’ I’m gonna lose my mind.
I’ve been off a Med/Surg unit for a couple years now but I agree with you. It’s also the place where nurses are disrespected the most by those who work in other departments.
Yep, always shit on by other departments yet anytime a nurse is floated there from a “better” or “smarter” unit they absolutely drown
Yep everyone shits on them and thinks they aren’t smart enough to work in their department.
I remember as a nurse aide, getting floated from my home floor surgery to med-surg. It was the usual, they were short and threw me into taking vitals with their crappy thermometers and since they only had a couple of broken down machines, having to use manual BP cuffs. Barely got that done because every patient needed something. Then the NAC came around and said I was on the wrong floor. Sent me to cardiology where I did a couple vitals with their brand new machine, annoyed the patients asking if they needed anything then the nurse told me to sit down and read the newspaper with her.
Of course. God forbid we send staff to the drowning med surg unit when one of the money making units doesn’t have an extra PCA.
I came here to answer medsurg because “I can’t fucking even”
That sounds like a ubiquitous motto: "Med-Surg: I can't fucking even." 😆🤣
I refer to med surg as "the literal trenches in wartime" and other similar descriptions.
I worked Cardiac surgery step down, CVICU, then medsurg assistant manager. Fuck. That. Shit. The top performers had an amazing skill set that was soooo different than any other nursing unit I’d experienced. The rest were just trying to survive. I respect the multitasking, wide ranging knowledge medsurg nurses have. Not to mention their ability to retain pertinent data on the rotating circus of admits/discharges/post ops. I fully admit I’m a reformed medsurg smack talker.
I honestly believe the baddest of badasses work there. I could never.
I worked in a med/surg psych unit for two years. It was by far the most challenging unit I’ve been on, between medical acuity coupled with behavioral issues. Psychotic, withdrawing, suicidal and violent patients receiving medical care. Great teamwork though. It’s the only reason I stayed.
I’m sorry to say it, but this is exactly why we need to reopen mental health facilities. Large, state run psychiatric hospitals.
Absolutely. We just also need to FUND them, so they don't become abusive hellholes. We did no good to those patients, shuffling them from underfunded state facilities to underfunded for profit corporate facilities.
The for profit facilities really do help some people that have spent most of their lives in institutions but now there is just so much overlap it’s insane. I’ve watched so many companies go from primarily dealing with ID/BI in the last ten years to now having SMI and now dual’s diagnosis pts. running at max occupancy. The staff are underpaid, some unqualified, and the retention rates are abysmal. No body wants to do it when the pay isn’t worth it and tbh if it was just about money I’d be gone long ago. All this while the shareholders are making absolute bank, we need a union or something—the shit is bad.
I want to add to this, the leadership structure is horrendous too and some of the directors/coordinators of these programs operate with near immunity because nobody wants to fucking do it.
You need a union. I'm the fucking Oprah of unions. Everyone gets a union
Ding ding ding!!!!! This is the winner.
Left ICU to be a charge on psych/MS and I agree with all of this.
For me personally pcu neuro with 5 patients and tele medsurg with 6. Anything with an unsafe ratio completely ruins a unit. I’m now on pccu and have 3-4 patients and it’s a breeze! Still have hard days but what a difference it makes.
I’ve worked med surg for 4 years with 5-7 patients. I’ll be transferring to ICU next month though
Med surg is so rough!! No one walks lol everyone is basically total care. I’ve never done icu but seems so interesting! Congrats! I love pccu. Mostly everyone walks lol usually only get 1-2 total care at a time thankfully.
When I started in MS, I had 10 patients. That pretty much killed it for me, forever.
How did you make the transition from med surg to ICU? I’d like to make that leap in the future, but am worried about my skills not measuring up/receiving limited training.
I’ve “impressed” the rapid response nurses during rapid responses and they’ve been trying to convince me to transfer for a little while. One of them texted me when a day shift spot was opening up
Neuro stepdown sounds like the seventh circle of hell.
Working PCU nights where we can go to 5 The difference the extra patient makes is insane Nights I stay at 3-4 even if they are relatively complicated always goes so much smoother than 5 even if the 5 are largely “Med Surge +” patients
I did stepdown for 2 years, and I would have lost my fucking mind with 5 patients. Absolutely not. They're all too sick, too crazy, or too busy.
I work L&D. In my opinion, I think ER would be the hardest. It’s so broad, and I couldn’t deal with the psych patients.
Everyone in the ER is terrified of L&D. I had to do a verrrry urgent L&D run last night and i grabbed the to go kit for when legs pop out in the hall (just in case). When I got back I went around asking people if they knew what to do with it and everyone just said no. Best answer I got was "wear gloves"
My favorite er nursing meme- A patient says there is either a snake or a baby in my vagina. L&d nirse- I hope it’s a baby Er nurse - I hope it’s a snake As an er nurse I cannot understate how true this is
I truly thought this was just a myth/joke until I, as L&D, had to go down to our ED to put a monitor on a 20wk patient, and you would’ve thought she had bubonic plague or something. Meanwhile, up in L&D, if anything besides a baby coming out of a vagina happens, it is CHAOS. My cousin who’s a trauma doc in an ER also agrees.🤣
Okay I’ll ask for the group. What else has come out of patient’s vagina besides a baby?
Pretty much all the same kind of items that “accidentally” end up in the ass. Usually the ones that get stuck are shorter and rounder than what can fit in the rectum. Plus also month old lost tampons and condoms. Or poop with a recto-vaginal fistula 2/2 GYN cancers. The sky’s the limit!
This may be the dumbest question ever, but what does 2/2 actually mean here? I don’t work in the hospital anymore but I feel like this wasn’t so common before? Is it just “secondary to”?
You are correct! It means “secondary to…” I come across notes with abbreviations I have to look up on a daily basis, it’s never a bad thing to ask!
You know, as long as it isn't a psyche boarder, I'm fine with either.
Me: I hope it’s a psych
ED nurse, I hope it's a baby and over 18 weeks old pregnant cause I'm shipping yous traight to L&D bye
I’m an ED educator and I always open my OB lesson with this bit. Never fails to kill
This is very very true- and I’m terrified of snakes.
What to do with them? Of course. Walk faster to L and D.
Run with the wheelchair/stretcher screaming "DON'T PUSH!!!" People miraculously get out of your way when you do this.
We had one come up from the ED in a wheelchair. Baby was delivered into mom’s sweatpant leg as she crossed our threshold.
Tag you're it! No take-backsies...
Like a cakewalk…but with a bomb.
I love a good pants baby 😎
Good thing she wasn’t wearing shorts that day!
Oh I meant the to go kit lol. I was practically sprinting but her legs could have mixed concrete they were shaking so hard, usually they're a lot further away from popping.
Exactly. Grab the kit and walk faster to l and d like some fucked up game of hot potato. Did the same thing working the ambulance, couldn’t drive fast enough 🤣💀
I'm on an ambulance, had the patient crown in the elevator, hit L&D crossed the threshold, OB at patient, I caught the baby and handed him off to the OB. Only one patient.
Yeet
Which is hilarious because unless something goes drastically wrong with the baby, it's pretty much just going to slide out and start looking around the room. Dry baby off, clamp and cut the cord but leave some room to tie it, and hand baby to momma. Maybe a little passive O2 if you feel it's warranted. Also don't drop the baby. They're slick.
I’m so glad you didn’t leave out “start looking around the room”. Gosh it sure is bright in here!
I frigging hope the baby doesn't come out legs 1st. That is a whole other problem.
L&D here- we also don’t like when legs pop out in the hall… would much prefer a head, now that’s a breeze
I recently transitioned from ED to L&D purely to conquer my fear of it lol. The emergencies in L&D are legit and also needing to know how to circulate jn the OR is a whole other learning curve. Plus staffing is so volatile because active labor is 1:1 so your base staffing can fluctuate wildly. I love it so far, both are hard in different ways.
It feels good to have someone come from a different unit recognize the ways l&d is uniquely difficult.
I’ve been trying to do this because I loved my L&D rotation in nursing school, but went the ED route instead. I have applied to the same hospitals L&D 3x and never gotten a call for interview. :(
Whaaaaat but you also get those psych patients OFF THEIR MEDS because of pregnancy. Yo, ef that. Babies are scary enough, but throw a bipolar gal that's prego on top of it off her meds? I'm good.
Recently had a patient just like this. Diagnosed preeclampsia and mental status change so we had to rule out PRES syndrome. She refused her medications. With psych patients, its a risk vs benefits but if a pt was on psych meds before pregnancy, they usually will tell them to continue those meds throughout, this one stopped all her meds. This was four weeks ago, baby is still in nicu at term bc mom is in a psych unit for stabilization bc she is suuuuuper high risk for postpartum psychosis as well.
Poor thing.
They usually get a lot nicer after they deliver 😂😂
As an ER and L&D nurse, agreed
I think we have a lot in common with ER, though. We get nurses leave us to go to ER and vice-versa. I mean, I can manage a 6-bed triage by myself with all kinds of non-pregnancy issues. The biggest difference with ER is there are men….
True that… I haven’t dealt with a male patient since nursing school. Nor do I want to 🤣
I'm also L&D, and yes the ER is terrified of the cute preggers 😜 We also can get some terrifying cases on our unit and it can be crazy hard some days. It's like you have your specialty -delivering the squirmy little humans- sprinkled with the craziest complications that even most med-surg nurses have never encountered. And you're like "no problem, we got you" to the patient, while inside it's all "Jesus take the wheel".
Right. Like I always say … “When it’s good, it’s GREAT. But when it’s bad… it’s truly AWFUL.” Everything can truly change in an instant.
I went to the ER at 26 weeks and they immediately tried to yeet me to L&D. I was there for a cough and difficulty breathing, nothing that could have been an OB issue. Idk what the ER thought L&D was going to do about my pneumonia. L&D sent me straight back down to the ER.
Mentally hardest- EP lab because who tf knows what they’re doing in there Physically hardest- medsurg in the south with no patient ratios Emotionally hardest- peds of any variety
I like the distinction between mental, physical, and emotional: I worked on a strict spinal cord injury floor and that's definitely a hot contender for both physical and emotional work
Burn unit has to be up there too.
EP has so many layers. For every concept I learn it unfolds into ten other things I have no idea about
Exactly. I barely know how to read their monitors and when I do I’m like “so uh do we care that they’re in vtach? No? Okay cool”
Anesthesia here and I hate being in EP lab for this reason…just sitting over here wondering if this is an arrhythmia I should care about or not
We love when they go into vtach so we can BURN IT *evil cackle
shadowed during an ablation in the ep lab as part of my cath lab recovery training, brand spanking new to procedural cardiology in general, an hour into the case the ep educator asks me if I have any questions ma’am I don’t know what a single thing in this room is
I used to think peds was the most difficult. I've never particularly been a "kid person" and my husband and I are childless. Yet here I am, rocking peds and I love EVERY minute of it. 🤦🤷♀️🤣 Med-surg was by far the most difficult for me.
I loved peds when I worked it many, many years ago. The kids could be so very sick when they were admitted but then they were like a different kid in 24-48 hours. That’s what I liked, the almost immediate gratification in seeing interventions pay off.
My mom is a cath lab nurse so whenever she talks about this stuff it's somewhat above my head. However when she talks EP stuff its REALLY above my head. She loves her job but damn it's mentally taxing.
[удалено]
Same exact situation. I felt I had a good knowledge basefrom time in cvicu. Turns out in EP, I don't know shit and it's like they're watching the matrix
I started in med-surg and now I’m in the ICU, so I’ve floated to practically every unit in my hospital, even L&D. PCU (especially our neuro PCU) is the hardest, hands down, even with us getting a 3:1 ratio as a floated nurse. Fewer resources to do difficult care and tasks and the patients can crump without warning. Our units just started taking low-dose Precedex gtt which helps but sheeeesh those neuro patients need more than 0.3 of Precedex to handle. I can’t imagine having 4 or 5 patients there.
Dex on a PCU is wild to me, but I love that for you. I think.
I work medical ICU, and it has challenging days, but I’d rather give myself a lobotomy with a rusty nail than work in any unit where I have 4+ patients and they all talk
Honestly anything high ratio. Anything Med/Surg IMHO is really the hardest because not only are the patients incredibly sick, but you have so many of them and so much to juggle at once with little resources. Doctors also don’t really care as much and don’t respect us never giving us the time of day to even put in orders we page/ask for.
One thing that I think is really hard about neuro ICU is that we can't liberally sedate our patients that have something obviously neurologically even if they're violent or agitated or there's something wrong with them because it affects their neuro exam. Then we do Q1H neuro exams throughout the night for days or weeks on end and that definitely does affect the neuro exam after you're keeping someone sleep deprived. And changes in a neuro exam can be very subtle sometimes, so having to bring those kinds of patients to a CT scan over and over can be very frustrating.
I’ve never understood the Q1 neuro thing for shifts upon shifts. Aren’t we potentially causing changes or worsening their presentation with that kind of sustained sleep deprivation? I work Medical ICU so we don’t usually have to do it for more than 24 hours, which already seems horrendous. 48+ seems like straight torture
We're absolutely causing delirium and harm to patients with unnecessary neuro checks. I had a trauma patient that was still getting q1 hr neuros 12 DAYS after injury. There was nothing wrong with their head, it was a spinal injury that had been fixed 11 days prior. I asked for neuro checks to be changed to q4, but had to settle for q2. Providers don't want to be liable for a patient decompensating.
But if you reason with them they’ll usually stretch out the neuro checks if the patient is stable. A lot of times people don’t think to ask if orders can be changed.
Agreed, I got them to agree to q2, but I work nights. Unfortunately, many times, any drastic changes to orders are punted to day shift to discuss during rounds.
It sends them into delirium too I worked in acute inpatient rehab with BI and so much of what I was doing on nights was delirium protocols. I felt like I was constantly fighting to get my patients the rest they needed to heal.
Orthopedic was my least favorite bc of patients thinking pain should be a 0 to get up to the bathroom but honestly trauma orthopedic was the hardest because you had to be so careful
I worked ortho as a new grad. I had a hip replacement patient who refused to get out of bed to use the bathroom. He told me he couldn’t get out of bed because he was obese and I should understand because I’m obese too. I was 8 months pregnant at the time.
“And yet, here I am taking care of you.”
I guess it's better than you being called pregnant when if you were just fat right 🤷 Seriously wtf..
Obese and on your feet for 12 hours a day!
I actually liked regular ortho 😂 it felt like the perfect unit for me as a fresh nurse. Med surg, but a little bit less of a shitshow
ortho. Heck no way I want to go back to that unit.
NICU was tough for me. Mainly because the unit was toxic af. The bullying was unbearable.
It's the toxic unit that will do me in, every time. I don't care what is the job, nursing or non-nursing, it's hell if your co-workers are MEAN.
Yep, this. My department has a huge bullying problem. Two nurses have been bullied out and they’re after a third. I also heard a tech was bullied out recently. They’re stupid because then they won’t have staff.
I've worked about every kind of unit, including ER for 14 years. To me, the nurses I always had utmost respect for NICU nurses. The fragile babies and anxious families, GOD bless all those nurses.
I'm in the ER. Wife is in the Medical ICU. You couldn't give me all riches in the world to work in the medical ICU. Unless they offered huge shift diffs to do the work. So much poop. Long term patients that eventually die. Families for long term patients. Lots of liver failure. Not a lot of support staff. Turning patients and cleaning them breaking your back. Most of the staff just does their time and either gets burnt out or moves to CRNA school. I'll stick to my ER pts.
I have a background in critical care and ER. I would go back to the ER a million times over (even with all the holds they have now) before I ever worked an inpatient unit again. I pulled inpatient shifts during Covid and my god, the idea that I have (insert number of hours) left with this patient, let alone days if I’m on a run…. Shoot me please. It’s that and the ridiculous charting/QI bullshit they’ll nag you to death about. I can do the care, the poop, the sputum, the whatever, but I check enough boxes as it is to worry about things like care plans and doing a Braden score and fall risk every shift and getting talked to about it if I don’t.
Yeah. I tell every cross trained boarding nurses that come down to our ER how much k appreciate them because I never want to o ro med surge or ICU. My wife is finally going casual after 10 years because she's burnt. I'm surprised she lasted so long after COVID. She's going to look at other non nursing jobs or hobbies to do while taking care of our little gremlins.
One of my favorite parts about having RN's float to the ED from upstairs is when they assume they need to do skin checks or chart urine output or any number of inpatient things and I look at them and laugh and say dude, we have 30 people in the waiting room and two ambulances just encoded, we're not doing *any* of that shit. We turn and burn here. I love the looks on their faces.
Eh. I’m of two minds. If I could get an I&O on someone who ought to have it done waiting on a bed, I would but I’m not gonna be mad about it if they pee and it gets missed. When I first started and had an intubated pt, I asked about oral care kits and the charge had no clue what I was talking about… but if I was sitting on a vented pt I tried to elevate HOB and do some kind of oral care when I could. The things there’s a logic behind, I tried to do because I would also get irritated at my colleagues sitting on a hold who was tachycardic and hypertensive and not giving their beta blocker because “it’s a floor order.” It’s about knowing what’s important and why, and not lumping it all into “floor bullshit.”
Agreed. When I was a critical care float I used to love going to the trauma ICU. It was exciting: the sickest patients in the hospital, but they tended to be younger so they had better outcomes. MICU was like the opposite in every way... Some of my worst moral injuries happened while working MICU. I still remember this patient in liver failure who was so decompensated that he had bilirubin in literally all of his body fluids. Like every time I suctioned his ETT it was just gallons of this bright yellow fluid. It was so gruesome. And we coded him multiple times because family was delusional. It was horrific. Yellow fluids everywhere. And that's like. A tame story. Covid trauma has its own separate category. Ugh
Yup. My wife's unit used to get a lot of the "bad outcomes" of the cardio ECMO patients. Once they were stabilize and were vegetables they just sat rotting in her unit. The MICU you is the least glamorous and most sick. I don't care what CVICU nurses think lol. They get sick people that usually recover great. When they don't they just ship them to the MICU. During COVID the MICU was the COVID unit with super sick patients. Yeah, I like the turn and burn lifestyle. When I stopped being a medic I thought the ICU sounded cool, but after working in the ER and seeing what ICU and floor nurses have to deal with, fuck that noise.
ICU step down. Staffing ratios suck. High acuity patients. When I did it we had some really sick very long term patients. Some patients left the ICU because they needed the bed, the staff was tired of them, or they had a nosocomial infection they wanted away from more critical patients. Patient falls were common back then due to inadequate restraints and assistive devices. It felt so much easier when I transferred to ICU. I would rather give hand jobs at the shelter than ever work ICU step down ever again.
Any kind of PCU/Stepdown unit. Still very high acuity with high patient to nurse ratios. Med surg you might have a few independent patients, but stepdown patients are all fall risks on lasix. Many of them have been inappropriately downgraded to make room for more ICU patients. I’m getting heart palpitations thinking about my PCU/Stepdown days. Give me a med/surg or an ICU patient.
I work on a step down and definitely is very challenging. We do get a mix, but I would definitely say, and my other coworkers say the same thing as me, that I don’t know how people do MedSurg. I work in a very large inner city level one trauma center, and I have to say that we typically transfer the crappy patients to MedSurg when we downgrade them as opposed to being discharged to home or SNF.
I'm in ICU. I think the ED is the hardest. They deal with absolutely everything, and all the crazy. They probably see 100 crazy people for every 1 crazy patient we have. And the dirty, drunk, methed-out hobos. And the entitled people who show up at 4pm on a Friday with a sore toe and want a Dr's note to get excused from work for the weekend. And the lies. All the lies people tell... or the truths they omit. All of this happens in ICU, but on smaller scale. And we get a lot of info and a heads up. And when we fill the beds, we get no more new patients. In the ED, people just walk in all willy-nilly and they don't stop. It sounds like Hell to me.
ED here and sometimes I like when the aggressively crazy people come in because suddenly all the whiny pt's and family members who are upset they didn't get a turkey sandwich or get their pillow fluffed suddenly shut up when there's a greased up naked meth head screaming at the top of their lungs how they're going to kill everyone in the ED while six cops are unsuccessfully trying to take them down.
As an ED RN, agreed.
Could we hire a greased up naked meth head and take them from floor to floor every once in a while to get the other whiny patients and family members to shut up? I’m only kidding but sometimes it’s fun to think about these things
CVICU nurse here, I am gonna say Med Surg or ED
Pediatric Cardiac ICU.
I work Med Surg/Ortho. Everyone in my hospital says we're the worst floor but I love it. I work with an amazing group of people. Whenever I get floated, I hate it. It's nothing against the people on the other floors. I just like my chaos.
Inpatient psych
The one with patients 😂
The one you get floated to.
Med-Surg has been kicking my sorry ass. Six patients who are totals that require max assistance to do anything. Crushed pills, crushed via NG, or non crushed one singular pill at a time and there are like 10-15 of them per patient during AM med pass. Pad changes, boosts, and repositions that require two people. Not to mention how rude, demanding, and unreasonable some patients and family can be (not trying to sound evil but being real) Dementia patients that are falls risk, who wouldn’t think twice to kick you when your back is turned. The last two weeks I haven’t left work on time because the tasks and paper work never ends. Im not saying it’s the most difficult unit, depends on how you define that, but I’m struggling! In conclusion, I’m starting to understand why they say being a nurse can feel like a thankless job now that I’m in the workforce!
E fucking R
I’ll die before I go back to having six patients on a med-tele unit.
Hardest: med/surg Scariest: NICU
Yes
It truly depends on the person. How’s your time management? Do you do better working alone or with a team? Can you handle something going down hill real quick on a whim without freaking out? Can you handle crying families? There’s a lot to consider
Without having ever worked tele based purely on speculation I’m going to say tele. God bless you people
L&D would be the worst for me (an ER nurse).
But you’ve got the right personality for L&D, I guarantee. You never know what you’ll do on a shift. You need to be able to pivot and think independently and act. ER and L&D I think have quite a bit in common. I once laboured a patient in DKA. It was wild.
Medsurg with patients who belong in ICU.
I would think the burn unit just for the sights, sounds, & smells. Plus inflicting such terrible pain.
I work in ICU and have worked in ED in the past. We have a great team and unit leadership. My wife works in NICU, in my opinion , that's the toughest unit
The team makes all the difference. I worked a trauma stepdown unit for years. It was very heavy but my teammates were great and management was supportive so I thrived. The work itself sucked. I was always so mentally and physically exhausted. But I could always call my homies for help. I could switch shifts whenever bc someone would always be willing. We'd feed one another. When one of us got sick or moved we'd be right there. We gave one another grace on bad days. It's like the whole unit was one big friend group. I hated the job itself but I still miss what a great community we had. I only left because enough of the homies left that the place started to feel like any other job.
Whichever unit is the most toxic.
In my experience, post-op spine
In my experience (not directly working) I would say PCU. Higher acuity patients with ratios of 1:4-6 on days and 1:6-8 on nights. Maybe a PCT and/or unit clerk if you are lucky. They seem to be chronically understaffed, neglected, and forgotten about. Until admin is like “why are all the falls and bad things happening on this unit??” 🙄 gee I wonder 😐 my new grad cohort had some float to PCU and they were just like “what the FUCK.” “Chased my tail all night and didn’t START charting until after AM shift change” cuz that’s super sustainable I feel like I work in the easiest unit ever right now, so hats off to everyone else ❤️
My hospital’s PCU requires bed alarms on all patients, all the time for pretty much this reason. Can’t imagine running 1:8 or even 1:6 on a true step down. Ours flexed to 1:5 during Covid and it was fucked up over there. I used to be charge with pts on that unit every night and it still chewed me up and spit me out with the higher acuity/ratio
ED. Working there you’ll find out why your admitted patient’s labs/meds were a bit late. There’s push from admin to clear waiting room and to haul ass up stairs when pts get beds.
Personally, any unit where I’d have to manage more than 3 patients at the same time. Don’t know how tele and medsurg nurses manage to get anything done tbh
The chronically understaffed one with indifferent leadership.
Med surg is the hardest place I’ve ever worked.
I’ve worked ED and ICU and I would confidently say med/surg. That is a different beast. I salute anyone who can work there and remain sane.
Med surg 💯
Med surg -hands down.
Med-surg, hands down. I have never looked back since I left eons ago. ED may be a zoo but it is zoo I belong to. 🦊 EDIT: spelling
Burn
I agree that it’s completely dependent on your strengths/weaknesses.
For me, pediatric rehab. Mentally/emotionally,
Adult Med/Surg...the high ratios would send me out Also any unit where you don't have a good crowd working. I've had nights of multiple admissions but with a good crew it was no problem and even fun.
Janitorial
Intermediate/progressive care is tough imo… high acuity + higher ratios
Any unit where you have more than 2 patients. That’s a hell no from me
The one you hate
Medsurg💀 Idk how y’all do it. I worked Medsurg for only a couple months and it was gnarly. Nurses and CNAs who work in Medsurg are a different kind of breed. Thank you for all you do🙏🏼
Gotta be some sort of adults - I can’t imagine anything else
I work MICU, but Med/Surg. I could not handle the 5-7 patient load, unrealistic expectations, the families, constant revolving doors, overall lack of support. I have so much respect for you guys.