Handling multiple ICU patients in the ER

[amzyRN]

I will be finished with orientation soon and am pretty nervous about starting on my own. I've noticed that there are sometimes instances when we will have to manage multiple ICU patients. How do you handle a septic shock patient on 2 different pressors that need titration, a GI bleed getting a central line who will need blood and pressors, and bad COPD exacerbation that needs respiratory treatment now and might need to go on BiPAP, plus you have a demanding psych patient in your other room who's ripping out their IVs?

In a case like this, I would have to ask for help as I don't think I have the ability to do all this on my own. How does a new ER nurse go about being safe and effective? I will ask for help for with anything that I can't handle on my own, but also don't want to come off incompetent.

[Lunah, MSN, RN]

That is when you talk to your charge about spreading the love. Sometimes we have those days when it seems like every patient is high-acuity sick-sick, but often the load can be redistributed because someone emptied their rooms and got the next few patients who happened to be bad. I have had those days in which it seems like all your patients want to go into the light at the same time, and those are very stressful. You literally prioritize by ABCs.

Do you have sitters for psych patients?

[canoehead, BSN, RN]

Notify your charge nurse that you are unable to care safely for your patients. Try to be specific, that if you could hand off Mr X and Ms Y then you'd be OK. Document in writing that you did so, perhaps noting the time and sending an email to your manager when the shift is over. (And email yourself too) Write up notes when you get home describing the load, and the response from your charge when you said you needed help. It's a management problem, on paper. Of course it's still your problem IRL. You have to run fast and cross your fingers during that shift. Prioritize, and delegate.

[BSN16]

At my ICU they also try to staff you in rooms right next to each other. For example i can peek through the window at my dopamine drip for pt. 1, while i'm watching my demanding psych pt. Also, do you have aids in your unit? If so you could delegate some tasks to them. If not, generally my other co-workers will help with a rowdy patient

[Lunah, MSN, RN]

At my ICU they also try to staff you in rooms right next to each other. For example i can peek through the window at my dopamine drip for pt. 1, while i'm watching my demanding psych pt. Also, do you have aids in your unit? If so you could delegate some tasks to them. If not, generally my other co-workers will help with a rowdy patient

Though this question does mention ICU patients, it's taking place in the ER. :) But it is helpful when your assigned rooms are close to each other! Doesn't always happen, though.

[BSN16]

Though this question does mention ICU patients, it's taking place in the ER. :) But it is helpful when your assigned rooms are close to each other! Doesn't always happen, though.

Oops! I read the title (and MOST of the content) so i just assumed

[sammiesmom]

What a mess! I would probably be screaming, "I need help over here!" like a banshee.

[AZQuik]

Yup. Need another nurse or a few techs/medics. Managing several icu pt's is possible with enough help, remember in the Ed we stabilize. You can do this with enough help. You will not be able to provide icu type care which promotes healing. That is not possible with such a load. That said, it takes time. You would basically turn into central command delegating and taking info back so you can coordinate care.

[William2]

I will be finished with orientation soon and am pretty nervous about starting on my own. I've noticed that there are sometimes instances when we will have to manage multiple ICU patients. How do you handle a septic shock patient on 2 different pressors that need titration, a GI bleed getting a central line who will need blood and pressors, and bad COPD exacerbation that needs respiratory treatment now and might need to go on BiPAP, plus you have a demanding psych patient in your other room who's ripping out their IVs?

In a case like this, I would have to ask for help as I don't think I have the ability to do all this on my own. How does a new ER nurse go about being safe and effective? I will ask for help for with anything that I can't handle on my own, but also don't want to come off incompetent.

Ask for help? If you have an art line titrating pressors isn't that stressful unless you have no pressures to be begin with. Depends if you are just starting out or assuming care with all this initiated. Sure all that stuff is busy to begin with until you get things settled down. And if not ask for assistance from the people you work with. Our peeps are pretty good with anticipating your needs and seeing you haven't been out of a room for awhile therefore ask if they can do anything for you. Its not a one man team that's for sure.

[applesxoranges, BSN, RN]

I'll be honest. It is unsafe how some ERs are run. Some of the most unsafe areas are where people are expected to take care of 5 patients that are the equivalent of new admits and one or two could turn into an ICU. Some people will give you crap too as part of hazing.

[MaxAttack, BSN, RN]

Sounds like your ICU needs better staffing to handle more admits.

So does mine. It gets old for us, too.

Prioritize and delegate. Then raise hell because God knows they don't care if you have one or six patients as long as their budget looks good.

[siegolindoRN]

Those are the days where teamwork is paramount for both safety of the patients and the nurses. As many have mentioned, manage up for assistance, don't assume you will be helped by maintaining silence. Don't just involve the nursing side but also the physician group as well. AmzyRN, your situation is an "all hands on deck" event!