[HazelLPN]

We have several types of ancillary staff.

We have one nursing assistant (I) per shift. The NAI is either enrolled in nursing school or is a CNA. They peform duties such as stocking rooms, setting up for admissions, running erronds for the unit clerk or charge nurse. They are trained in basic patient care...often serve as an extra pair of hands when a patient needs to go off the unit to CT or MRI. They are assigned to the charge nurse and generally help anyone out who needs it.

We sometimes also have one nursing assistant II or nursing technician per shift. The NA IIs are nursing students enrolled in registered nursing programs who have completed either peds or have had a critical care rotation. The NTs are graduates of a nursing program who have yet to take their boards or who need to re take them. The NAII/NT is assigned to an RN and they do what we call "PIP" which stands for Partners in Practice. Most of our kids are on 1:2 care, a PIP team will take three patients on 1:2 care or on occasion they have taken a 1:1 and 1:2 or 1:3. The NAII/NT can assess under the direction of an RN, do dressing changes (though none around central lines), give ng/og feeds after the RN has checked placement, and can assist with ETT suctioning if the RN is present and helping. NAIIs/NTs can not give any medication, but they can re set pumps if the RN is directly supervising them. Its an excellent way to get ones feet wet in critical care. Most take positions RN positions in the unit as soon as they graduate and pass their boards. If an RN or LPN is mandated to float to the PICU from the floors, they usually are put on a PIP team with an RN and fuction as an NAII/NT unless they feel comfortable working on their own...and even then they are given a lot of help by the rest of the staff.

Always one unit assistant (formerley unit clerk) per shift. They are cross trained to assist with basic patient care, but most of the time are too busy with order/phones/putting out fires to help out that often. On nights they sometimes help with baths and weights when not busy....or serve as an extra pair of hands when needed. Many are pre-med students or nursing students and go on to bigger and better things once they graduate. One young man is now a pediatrician....and other young woman became an LPN in the unit.

We also have three LPNs in the unit, which are not considered ancillary staff but part of the nursing staff. In my state and hospital, LPNs are allowed a full scope of practice...we can do IV meds, hang blood, titrate our own pressors, take physician orders, draw gases etc. We do not do the initial assessment and therefore do not take new admissions. We also must check many IVP meds with an RN before administering them.....the same with blood products. The charge nurse never takes a patient assignment, and is resonsible for covering us if something comes up not covered under our license. We do not delegate to nursing assistants and never have a PIP team. We also do not initiate a care plan and serve as the patients care manager, though we help with the process by giving suggestions. We also do not train as ECMO techs, and very rarely help with the care of ECMO patients....if the kid is 2:1..two nurses and a tech.....they will sometimes use us as the second nurse.

I've seen so many models of nursing in the ICU come and go during time. This one seems to work the best. We need good future critical care nurses....and let's face it....you don't learn critical care in school unless you do an internship. PIP is something similar to what I did back in the dark ages in nursing school....where you pretty much worked with another nurse one on one...and when you earned you diploma you knew your stuff and could work anywhere in the hospital. It was mentoring....something we have gotten away from these days. Like I always tell young people in school...you really learn your stuff by doing....not by reading about it in a book.

[PIVputterinner]

We use techs but they don't do much patient care, they help the RN bathe, change beds, transport, and they do finger stick labs. But mostly they stock the bedside, run to blood bank or pharmacy, and sometimes if we have a baby that is well enough to take a bottle, they can feed them. We also have clerks that take care of the charts and phones.

[PIVputterinner]

HazelLPN, where do you work. LPNs in the State of OHIO can rehang a running fluid, but only RNs can give Push drugs and titrate drips or take verbal/phone orders. The PICU where I work has no LPNs, If fact before I got my RN I was an LPN and the last one to work in the PICU.