On our ccu we get anything cv related now with our cv surg docs (ie cabg, valves...) for our patients we have about 120 different standing orders. Ie: Draw any labs any xrays, ekg's. Start amio for afib, start lopressor if needed, neo, nipride, mag, k, lasix, albumin, hespain, insulin gtt ntg, we can start/titrate/dc almost 40 different drugs (all without directly talking with the md first) dc aline, place or d/c f/c, d/c swan, d/c central lines, and the list goes on and on. All without talking with the md first the and god forbid you call them for one of these things esp at night unless the patient is dying b/c they will say you have a standing order for this and hang up. Pa's donot round in the ccu only on the step down units, often the cv surg docs make rounds by asking the rn's "how are they doing" then writing a 2 line note in the chart and moving on. I know this is not the best way to practice however we are ranked #1 in are state for overall cv surg outcomes. I just want to know if anyone else is exposed to this type of unit? Is this common?
Apr 23, '09
Sounds like where I worked, except PAs & NPs did round, prior to the surgeon or cardiologist rounding.
It worked for us, the patients, and the docs. We had some standard protocols, and then each surgeon had his/her own that would be added in.
As far as I know, this is a common format in this type of unit. I really liked working from protocols myself, and never felt unsupported. I worked with a really great team, with a wealth of experience, though.
Apr 23, '09
I hear frustration in your posting. Has there been a problem where you felt alone and floundering? Turn to your experienced co-workers. When you have questions or need clarification, ask for help. Any Unit that does not foster learning and collaboration among colleagues is not worth staying in. The standards to which you refer are written by medical/surgical/nursing committees and are very common across the board. But they also require you to think and act professionally. Keep in mind your patients' safety, ask for input from co-workers, evaluate your patients' responses to treatment and you should do OK.
Apr 23, '09
I, unfortunately do not work in a unit like this. First of all we don't do open heart anyway (wish we did!). But I think any ICU ought to have standing orders as far as replacing lytes, ordering certain labs, x-rays, ekg's, starting/titrating drips. I think it benefits the pt to be able to do something for them right away vs waiting for a doc to call you to give you orders.
Apr 23, '09
If your Unit lacks protocols (i.e. standing orders for labs, EKGs, etc.) then you are not following evidence-based practice. Speak to your Unit supervisor and/or a more progressive physician who might be open to exploring these options. Remember, these protocols emerge from combined committees that use evidence-based research to write their protocols. No two facilities will write exactly the same protocols, tho they may use the same research to write them. Medicine and nursing are collaborative practices and a team approach is best for patient-centered care. Sometimes it takes only one nurse to push for advancing the practice in a facility. There are several studies that show the benefit of using these types of protocols.
Apr 28, '09
I actually have been on this unit for several years. I like how we can do most anything without bothering the MD. It is really others (from other departments) outside looking in who are thinking we are doing way to much (out of our scope). I dont think so, just wanted input from others.
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