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???