ICUmanager 470 Views
Joined: Dec 13, '08;
Posts: 5 (20% Liked)
; Likes: 2
We restrain our vented patients about 80% of the time. I've seen many vented patients that can tolerate the ETT without a bunch of sedation and/or restraints. However, we often restrain during periods of sleeping or sedation due to the patient possibly grabbing at the tube while not in wakeful state. We've also had patients that are unrestrained most of the time and then request restraints when they know that they may need them. I've also unrestrained several patients that didn't require them without self extubations. As others have mentioned the self extubations I see are on those who are IN restraints.
You may want to look at some research on this. This has been against practice standards for more than 17 years now!!! It appears to work, but you are actually doing more harm than good. I wouldn't want you caring for any of my loved ones if you are unwilling to provide evidence based care.
Is your travel contract in the ICU? I believe that if you were uncomfortable with caring for vented patients that it should have been made clear during the assignment of such a patient. Also, we have always had travelers that had their skills/experience made clear during the recruiting phase. If this was a rare assignment that you will have I would recommend a little refresher on vents just in case you run into this again. If R.T. is available where you are, I would recommend that you spend 20-30 minutes going over the ventilators. You can access a lot of information on-line regarding ventilator modes and safety, however your peers would probably be best at providing information regarding ventilator safety and what to do in emergencies since they are familiar with the vents, policies, procedures, physician preferences, etc.... Hope this helps.
I believe this is completely unsafe for the patients and the staff. I would have the ICU nurses go to their manager and if nothing gets done I would go above the manager. I'm sure your manager and administration would not want a nurse caring for their loved one or themselves in the ICU by a nurse who didn't have adequate training in critical care. Over-time is much less costly than a lawsuit or increased staff turnover.
I see a lot of new graduates do very well in the ICU and I've also seen others do poorly. I believe that you must really.... want to work in the ICU first and then you must also have a lot of self initiative and motivation to get the experiences you will need to safely care for your patients once your orientation is complete. It also helps to spend time self studying at home. Unfortunately most new hires end up on the night shift where there isn't much support, your peers can often make or break you. It is very important to set limits on the acuity of your patients especially during your first 6 months on your own. It isn't uncommon to find the newest nurse taking care of the sickest patient due to them "needing the experience", however when your support nurse gets overwhelmed with their own assignment you are left alone in a potentially unsafe situation. There's also the nurses that tend to "eat their young" but if your motivated and have critical thinking ability (not everyone does) then they will learn to respect you. Good luck!
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