[dutchesstee]

I work in Minnesota, we do have resp therapists that actually set up the vents and change the settings on the vents but we help with intubations, start IVs draw labs, do the baths, wts and all the other care. And because we have residents that change every month we need to be very ontop of all the normal orders and accepted practices and doses as these residents are only there for a month and as residents are learning. It is very scary to not ber able to rely on the MD to do the best thing as far as the pts medical needes go, and the intensivist expect that we will "catch ' the residents mistakes.[FO./NT=Comic Sans MS]undefined[/font]

Originally Posted by UK2USA

Here in the UK we staff 1:1 for patients in the PICU (at least in the hospital that I work in). For an 11 bedded ward that meeans that we usually have 13 staff (1 charge nurse, 1 runner / support, 11 bedside nurses). If we need help with further admissions then we have a clinical response team within the hospital that usually has at least 1 other PICU trained nurse.

I have found in interviews with US hospitals that unit managers are very surprised at this staffing level and are concerned that British nurses may not cope with a higher ratio than that, but let me put your minds at ease.
The 1:1 allocation is mandatory here in the UK (Department of Health: Bridge to the Future 1997).

However, just to show you guys that our days are not spent with our feet up:
We are responsible for all of the care given to that patient, so....
We make up and administer meds, we turn and wash the patients, we analyse ABG's and alter ventilation settings, we provide most of the respiratory therapy, we assess nutritional status and commence feeds as appropriate, we manage the RRT (and ECMO) and make the adjustments to these therapies that we feel are necessary, we often manage the codes etc.

Do the US nurses have the same tasks in their work, or are these tasks allocated throughout the multi-disciplinary team? I would be interested to learn prior to arriving in the US with my green-card.

[megcaffrey]

The number of vents relative to the number of PICU nurses is what determines our assignments. We try to split them up, but given the staffing crisis and the lack of experienced PICU nurses, us old-timers are taking 2 vents at a time more often then not. I feel like the SWAT team you mentioned is the answer to all of our prayers!! Do you have guidelines or a policy or job description about their role? I'd love to initiate that here!!

[linds2480]

I have worked PICU for the past 2 1/2 years now (right out of nursing school). Taking care of 2 vented patients is the norm around here. Our docs are pretty good about making sure the kids are on enough sedation to make it safe for them and us to leave the room. About the only time I have been 1:1 with a vented kid is if there are other circumstances necesitating (sp?) that staffing ratio. On instance would be HFOV. Otherwise, unless they are extremely sick and on several inotropes, they are paired.

[janfrn]

Multiple inotropes... we routinely have patients on epinephrine, norepinephrine, milrinone, sodium nitroprusside and maybe vasopressin too. (We rarely use phenylephrine, though.) It's also not unusual for our patients to have more than a dozen infusions running at the same time, intracardiac lines, multiple chest tubes, external pacemakers and are being actively cooled. We try to staff these kids 1:1 except for breaks, when we cross cover. The only patients who are not routinely cross covered are the ECMO patients, and even that has been changing. Our upper management is trying to do away with our resource nurse role which will effectively take away the only flex we have in our staffing. Things may get very dicey, given that our acuity is only going up...