[sunshineCCRN]

Hi everyone, I'm new here, but I'm wondering if anyone else's unit has this problem.

I work in a small hospital. Our ICU census is usually 8-11 patients. However, we take EVERY kind of patient short of a transplant. A recent census of ours: fresh CABG, a patient in 4-points, a vascular surgery, a sepsis patient, a craniotomy, a crashing surgical, a cath needing sheath removal, a chemo patient, a GI bleed....I could go on. We also do CVVH, IABP, and all stat/first responder/code team calls in the house.

While I like having variety, I am very leery about us getting complex surgical patients only sporadically. In my book, it's nearly impossible to be a perfect CV/neurosurg/MICU/SICU/CICU nurse all in the same week, when you only get to take care of a certain kind of patient once a month or so. Our hospital loves what the surgicals do for business, but it leaves the nurses and patients vulnerable.

Not to mention about half of our staff have less than 2 years experience (i.e. new grads who went straight to ICU).

Is this situation normal? Can anyone else feel my pain? HELP!

[jbp0529]

I feel your pain, Sunshine. It's frustrating at times bc we all have to reference/remember the non-cardiac stuff like ICP monitoring, trauma protocols, and so on. However I also like the occasional variety and I think it makes us better nurses bc we truly do see alittle bit of everything. My unit is an "open unit" whereas all the other ICU's are "closed." This often makes us the "dumping ground" for the non-medicine services.

The part that really stinks is that once we get comfortable with those particular patients, the doctors usually move them out and back to the ICU in which they "belong". All too often this plays havoc with our census... if we are having low cardiac pt census, the SICU/Neuro/Burn docs see that we have open beds, fill us up with their pt's, then a day later move them out and crash our census, forcing us to send nurses home or float, only a day later to fill us up again and restart the process. Very frustrating. This usually only happens in the summer; i expect once winter comes and our cardiac pt's get sick our census will stay more constant.

[sunshineCCRN]

Thanks for your input, jbp. I guess it's just frustrating since our unit is lacking in experienced nurses. Only 1 or 2 people per shift are fully competent enough to take any patient in the unit.

It's to the point where some people say "I don't take post-op hearts" or "I'm not going to take the CVVH or IABP class". I understand where they're coming from--how can you protect your license if you are forced to take a patient you aren't comfortable with?--but that leaves the rest of us swamped and overwhelmed, too!

[jbp0529]

I guess it can be tricky when you try and take care of pt's you dont feel comfortable with. If we get an odd-ball case from a different service and we have a question, we usually call a nurse from another ICU that can help.

Some of the really sick patients that arent part of our service often get moved out pretty quick though. I remember we got a cop who was shot multiple times to the chest and abdomen and came to us post-op... he only stayed with us about 4 hrs before they moved him to the trauma unit. Another time we had a kid with a partial C-2 fracture on a rotating bed...he didnt stay long either.

It seems like there is always someone who is willing to take these "exciting" patients, though. We dont often have nurses who say "i only take ___ patients", but if they do, then someone else is almost always comfortable enough to do it.

IABPs and CVVH...we put all of our nurses through classes to get certified in these, since they are pretty common.

I guess my point is one's license is probably always on the line, especially with the abnormal stuff, but if the nurse uses all his/her resources, then hopefully it wont be a problem. And hopefully if someone doesnt feel comfortable taking an assignment, they would say so and not get in over their head.

[jbp0529]

Just reading more of your response... we too have lots of new nurses ( i think more than 3/4 of our staff have less than a year experience now that i think about it ! ). Maybe we are just plain lucky that there hasnt been a problem LOL

[sunshineCCRN]

Thank goodness we don't have traumas. I guess it's just different in a small hospital. There have been nights when I'm the ONLY person in the house who can take a CVVH/IABP/CABG patient. So it ends up being me and a select few who are always taking patients we don't have much experience with. And oftentimes we don't have anyone else on the shift to pose a question to, unless we call the eICU...which isn't always helpful depending on their nurse's expertise. There are days when I want to say no because it could be more than I can handle, but there is no other option.

Not to mention our surgeons are very difficult to work with. Some make it obvious that our hospital takes a back seat to the main one. So when a patient bleeds out at 3am....it's either "why did you let him bleed?" or "get an H/H in 3 hours and don't call me until then". Grrr....

I guess I'm starting to whine now.... where is my cheese?

[jbp0529]

Sounds like you definately need backup to handle those higher acuity pt's and to run the IABP's and CVVHD... what if God-forbid something happened to you on your shift, who would cover your pt if you were the only one in-house who was qualified?? Can your manager put pressure on the nurses who dont want to take the certification classes for IABP/CVVHD step up and do it??

[sunshineCCRN]

Originally Posted by jbp0529

Can your manager put pressure on the nurses who dont want to take the certification classes for IABP/CVVHD step up and do it??

Yeah, she COULD....

[emmycRN]

Sound just like my unit. 12 beds and every kind of patient under the sun.

[mnurse3139]

I work at a hospital where we have an sicu that gets everything, and i dont see it as a problem. I enjoy having patients of all kinds, i love neuros, but i also do cabgs and iabps, i dont see why anyone would complain about it, I am always up for a challenge. But if you are not comfortable or interested in learning new things hey thats ok too.

Abel