[climberrn]

So my husband and his partner started a PICU in a community hospital. I'm a PICU RN and work there part-time. When he gets paged, I can hear most of the conversation and some of it just blows me away.

Doc: So, what rate is the vent on now?
RN: 27
doc: okay, let's take the rate to 25 and the peep to 7
RN: okay

5 minutes later, a page from the RN:
Um, doc, I messed up, I was looking at the wrong page of charting. The rate is actually 21.
Doc: okay, take the rate to 19 then. Wait, what are the pips? Pips. Peak inspiratory pressures. It's on the right side, top....

Um, you, the RN have ONE patient! How do you not know everything about that patient? How are taking care of a vented patient and not know the mode, PIP, what PIP is, for goodness' sake????

Another nurse put a CaCL gtt through a peripheral IV when the central line clotted off. Guess who's going for reconstructive surgery later? The lack of knowledge just amazes me. Am I off in thinking PICU nurses should know these things?

Vent over.

[traumaRUs]

I think its a system issue - how long is orientation? Obviously these nurses need more knowledge if they are to handle PICU-level patients. I wouldn't necessarily be quick to blame the nurses - it sounds like they are truly not knowledgeable enough.

What about your husband offering in-services? Parterning with the PICU educator to provide more info?

[janfrn]

You're not off. The nurses aren't being given the needed education to ensure they are effective in their jobs. The orientation process should be looked at to see where it can be improved, and some resources provided for those times when the staff on duty are not highly experienced.

One thing that your husband needs to do is to make it a unit practice for everyone, not just the nurses, that critical care infusions are looked up in a parenteral drug manual EVERY time they're used to check for where they can run, how fast they can run, how concentrated they can be and what they're compatible with, and that there are two nurse checks for high-alert drugs like CaCl. It's too easy to rely on one's faulty memory for things we believe we should know off the tops of our heads. Looking it up makes it harder to mess up.