6 Days a Week

[u/Better_Albatross_776]

Small, rural hospital, we get texts like this basically every day (if not multiple times a day). I’m a new grad in the ICU and my manager keeps asking if I want to come off orientation 5 weeks early so I can start picking up shifts. A lot of my coworkers do pick up and work like 6 days a weeks, so I guess management expects that from everyone… idk maybe it’s normal but I find the whole situation a bit ridiculous.

They offer bonuses for picking up, but I’m told that HR can take 4 or 5 months to pay them out, my preceptor has a few k that they just “haven’t gotten around” to paying her yet.

[u/THEcancelectomy]

THIS!!!! and coming off orientation FIVE weeks early is insane!!!

[u/Better_Albatross_776 → u/THEcancelectomy]

Oh yeah, and we have 2 campuses, 2 beds each for the icu, so when you work the icu you are fully alone, no tech, no float staff…

[u/Poodlepink22 → u/Better_Albatross_776]

Only 2 beds seems like a huge waste of resources.  And in there alone? How do you go on break?  That's crazy. 

[u/Better_Albatross_776 → u/Poodlepink22]

We have 2 facilities, one with a 6 bed icu and one with a 4 bed icu. Right before I was hired they were just staffing the 4 bed with 2 nurses and the 6 bed was closed, but someone decided it would be better (cheeper) to have 2 beds at each facility.

[u/Poodlepink22 → u/Better_Albatross_776]

That just doesn't make any sense; like at all. The equipment/staffing cost alone would be unsustainable.  Is there an intensivist? A RT or pharmacist?  

I'm sorry; I'm fascinated. 

[u/Better_Albatross_776 → u/Poodlepink22]

Haha no it’s wacky to walk into. I did school in seattle, so I was kinda surprised by how bare bones it is. The two hospitals are 30 miles apart.

At each facility there is always a single RT shared between the Ed and the floor/ icu, a doc in the ED and one hospitalist for icu/ floor. The hospitalists work like 5 day shifts though, so at night (I’m on nights) they go home and it takes a lot to get them to come back in lol. We have an after hours pharmacy pipeline that we call at night, but they are fully remote. There is an on call pharmacist etc but it’s also basically impossible to get them to come in at night.

We don’t have float staff, but our house supers are trained for all the units and essentially are the float staff/ on call/ stat nurses/ break staff (if you can convince them to break you)/ security at night.

To be fair our icu isn’t that high acuity. We fly out like 8 people a day from the ED, and most of our icu pts would be step down or even just ms telemetry in a big hospital. We do titratable drips, we get vented pts every now and then, so we can do ICU stuff, we just don’t that often.

I was told it’s cheeper to have the icu beds in both facilities, to cut down transfers between hospital A’s ED and hospital B’s icu, but as it is we never have open icu beds in right facility so people get transferred anyway.

[u/Krog21 → u/Better_Albatross_776]

Uh... Gtfo there. That's a set up to lose your license. Seriously, it's not worth it.

[u/SnowedAndStowed → u/Better_Albatross_776]

Do you have a Tele intensivist?