ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 7

by Scrubs911 34,671 Views | 129 Comments

*I posted this in the new grads section but I also want to hear from the experienced nurses* Hi. I'm a relatively new nurse in a general ICU (we get a variety of patients). Considering the shortage of jobs for new nurses, I'm... Read More


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    Yeah also I know the reasoning for wanting patients as least sedated as possible, but it seems kind of cruel. Do you never paralyze patients? Or have patients so sick that they need to be knocked out for patient/vent disynchrony?
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    I agree with everything IndiCRNA and Tothc2 are saying here. Voices of reason. Talking to some of these other posters is like
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    It was a code while having 3 pts. So, I didn't know the ratio/proportion...The ED doc said to slam it...The L bag was alreay made.
    The Epi was in a liter bag!!!!? You didn't know the concentration of the medication you gave in a code? How did you document how much you gave on the code sheet?
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    Quote from sapphire18
    Yeah also I know the reasoning for wanting patients as least sedated as possible, but it seems kind of cruel. Do you never paralyze patients? Or have patients so sick that they need to be knocked out for patient/vent disynchrony?
    Absolutely we do.

    All newly tubed/vented patients begin on a fairly standard infusion combination of morph/midaz and we go from there (i.e. increase and add other drugs [usually precedex for sedation, ketamine for pain and vallergen, choral hydrate and diazepaem down NG tubes once feed are started for sedation purposes] or decrease as tolerable (e.g. kids that are older and have been on the vent a while/are tolerating it -- we've had kids sitting up and painting on the vent).

    We paralyse kids where appropriate (newly placed traches are the main ones).
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    Quote from IndiCRNA
    The Epi was in a liter bag!!!!? You didn't know the concentration of the medication you gave in a code? How did you document how much you gave on the code sheet?
    I am thinking 8 mg/1000 mL of D5 (years ago this happened). Pharm made the bag, should I call them and ask the concentration?? The MD was running the code. And, I was not charting on the code sheet...I slammed the epi (as ordered) and was doing compressions and checking for a pulse after all ACLS efforts were done. Pt died. Are you happy now??
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    Quote from shakanurse
    I am thinking 8 mg/1000 mL of D5 (years ago this happened). Pharm made the bag, should I call them and ask the concentration?? The MD was running the code. And, I was not charting on the code sheet...I slammed the epi (as ordered) and was doing compressions and checking for a pulse after all ACLS efforts were done. Pt died. Are you happy now??
    You HAVE to know the concentration of anything you give. You just have to know. Would you give an unlabeled syringe of what pharmacy called epinephrine during a code? I wouldn't. I would want to know how much epinephrine I am giving with this syringe. If an unlabeled bag came from pharmacy I would go mix my own bag (or if you're busy with compressions have someone else mix it for you). Just because a physician tells you to do something doesn't mean you do it. Sometimes they get a little carried away during a code and get ahead of themselves too.

    Also - especially if it was a liter bag that came up. I've never seen epi in a liter bag. Red flag. I'll give you the benefit of the doubt though. Codes can be crazy and everyone is shouting and doing things and sometimes you don't know what you've got in your hands at first.

    But aren't codes the most exciting thing about your job? I loooooove them. So fun.
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    Quote from Dodongo
    Codes can be crazy and everyone is shouting and doing things and .
    I would tell anyone shouting in a code to leave the room. Our codes are always calm and pretty routine. Everybody knows exactly what their job is and how to do it. There is no confusion or shouting.
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    Quote from PMFB-RN
    I would tell anyone shouting in a code to leave the room. Our codes are always calm and pretty routine. Everybody knows exactly what their job is and how to do it. There is no confusion or shouting.
    Maybe after the first few minutes but when a code is initially called and its just the nurses responding before a physician or pharmacists arrives, no one really has a "set job". It's whoever starts taking care of what first. Codes are unpredictable and until an MD shows up there can be too many chiefs, not enough Indians.
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    Quote from Dodongo
    Maybe after the first few minutes but when a code is initially called and its just the nurses responding before a physician or pharmacists arrives, no one really has a "set job". It's whoever starts taking care of what first. Codes are unpredictable and until an MD shows up there can be too many chiefs, not enough Indians.
    *** Running codes is in my job description as full time rapid response nurse. Most of the time our codes are run by residents. Some of whom may or may not be running their first code. Occasionaly no physician arrives at the code until very late into it and the rapid response nurse runs it. I dispise confusion and yelling in an emergent situation and will ask anyone in a panic or yelling (sometimes it's the resident) to step out until they compose themselves.
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    Quote from PMFB-RN
    *** Running codes is in my job description as full time rapid response nurse. Most of the time our codes are run by residents. Some of whom may or may not be running their first code. Occasionaly no physician arrives at the code until very late into it and the rapid response nurse runs it. I dispise confusion and yelling in an emergent situation and will ask anyone in a panic or yelling (sometimes it's the resident) to step out until they compose themselves.
    Again, after the first few minutes. You are the rapid response nurse so once you arrive you can start directing the code. But if I'm the nurse taking care of a patient and they go into v-tach and I run in and they are pulseless I will start compressions while yelling/asking for someone to get the crash cart. And then I will yell/ask for someone to put the zoll pads on while I'm still doing compressions. And then I'll switch with someone and yell/ask for some fluids and yell/ask for some epi... so on. Until a designated "director of the code" shows up and everyone assumes their own specific duties. But unless you can predict which patients will code and go stand there waiting for it to happen, the first few minutes are pretty hectic because often times, it's not entirely expected.


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