What do you think???

  1. Our 24-bed CICU unit contains 8 intermediate beds (2:1 critical care/4:1 intermediates). These are generally walky-talky patients who require telemetry and interventional cardiac procedures. We all take our "turns" going there one 12-hour shift at a time and our "dates" are meticulously recorded by the assistant nurse manager on her "ledger." When our "time" comes, regardless if we are in the middle of a 3 or 4 day stretch, we are pulled to the intermediates ("GM's") to do our time. (I actually don't mind going there... enjoy the variety and break from taking care of the very critical patients... Sometimes the "GM's" are the only sane place in the unit... And then again, sometimes not ). Anyway, my point is--the way we are being pulled takes away from continuity of patient care. Typically, one can start a 3-day stretch with critical ICU patient assignments; THEN (day 2), get pulled to the "GM's;" on day 3--the same nurse given TOTALLY DIFFERENT critical patient assignments. I don't like this system at all. Generally it takes me the whole first shift just to get used to the patients. Go home and ruminate over patient diagnoses, medications, plan of care and things I should have addressed/could have done better, etc (reflective nursing). Day 2 (IF I have the same assignment) generally have a much better grasp and am able to "fine-tune" my care. I think the patients are being short-changed by these crazy bed-hopping assignments. I think we ought to be assigned to "GM's" ONLY at the beginning or end of our stretch of days... What do you all think???
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  2. 4 Comments

  3. by   SICU Queen
    I agree with you 100%. Unfortuantely, we do it at our hospital the same way, except we just get pulled up to MICU or worse, telemetry.

    Everyone is so worried about getting pulled that patient care takes a back seat. I've volunteered for pull on my first night back so that I can have my patients for the remaining two to three nights. This seems to work well for me. Maybe you can try that?
  4. by   Brownms46
    Kimberly

    I agree wholeheartedly with every word you have written. Maybe you could change your rotation which someone who sees this as a valid point also. I know there are always those who don't want to go against the dreaded.."it's always been done this way"...statements...but in this case I see a need for change. Also maybe you could prefix this concern you have...by saying...I'm trying to adjust to this unit and increase my organizational skills...and it would help if I could be able to take the (GM) assignment...first...and then a critical pts assignment.

    I mean I would let someone know that this would help to aleviate some of the stress you're feeling. You sound like a very caring, concerned nurse...and I feel that your observations are right on.

    Continuality of care is what it is supposed to all be about.

    Like mother said...nothing beats a failure but a try...so until you ask...you will never know what might have been changed if you had asked...
  5. by   Brownms46
    Originally posted by SICU Queen
    I agree with you 100%. Unfortuantely, we do it at our hospital the same way, except we just get pulled up to MICU or worse, telemetry.

    Everyone is so worried about getting pulled that patient care takes a back seat. I've volunteered for pull on my first night back so that I can have my patients for the remaining two to three nights. This seems to work well for me. Maybe you can try that?
    Dang...SICU Queen...ya beat me to the punch.....well said!
  6. by   babs_rn
    Well, frankly I have found it a rare beast that a staff schedule would allow for any continuity of care on 12 hr shifts. So many times we're working on one, off two, or on two, off one, or whatever combination. You had the luxury of continuity of care in the days of the 8 hr nursing shift because most people were on 5 days a week so the patients and the nurses got used to each other. With 12's and shorter hospital stays, I'm likely to have a different set of patients each and every day I work. So I don't really approach continuity of care as an issue in getting pulled. Frankly, life's too short for me to deal with all the wonderful theories that reality tosses out the window. I just care for the patients I have that day and go home.
    Babs

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What do you think???