ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 6

*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... Read More

  1. Visit  Dodongo profile page
    0
    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.
  2. Visit  PMFB-RN profile page
    0
    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.
  3. Visit  Dodongo profile page
    0
    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.
  4. Visit  PMFB-RN profile page
    0
    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.
  5. Visit  Dodongo profile page
    0
    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.
  6. Visit  Dodongo profile page
    0
    And just to be clear I'm not, and was never, talking about panic yelling. I'm talking about yelling so that everyone is clear about what I'm doing and what I need them to do.
  7. Visit  tothc2 profile page
    0
    As a rapid response nurse you're probably arriving to a code after the more chaotic period has passed and everyone has decided what they're going to take care of during the code. Like dodongo said, usually it's just the first couple minutes when everyone is caught off guard that are helter skelter. Even for ICU nurses that do it all the time. It's unexpected, your adrenaline is going and you want to make damn sure that everyone hears you and gets what you need.
  8. Visit  christyness profile page
    0
    Pts on my unit are 1:1 if they are very unstable, on an oscillator vent, or receiving CVVH. Otherwise, they are 2:1, never 3. If they are well enough to be 3:1, they go to the IMC.
  9. Visit  IndiCRNA profile page
    0
    Quote from tothc2
    As a rapid response nurse you're probably arriving to a code after the more chaotic period has passed and everyone has decided what they're going to take care of during the code. Like dodongo said, usually it's just the first couple minutes when everyone is caught off guard that are helter skelter. Even for ICU nurses that do it all the time. It's unexpected, your adrenaline is going and you want to make damn sure that everyone hears you and gets what you need.
    I work at the same hopsital and PMFB. I would guess he is already on sceen in about half of the codes. many times there are indications before the code that some thing is going wrong and the RRT RN is already on the case. He is right, our codes are calm and well run, no yelling or excitment is allowed. Even our tele nurses have to go to Sim Man lab and run code senerios. About the only time we have yelling and excitment at a code is if a code is called in a non clinical area, like the cafeteria. Pretty normal to hear low key off topic conversations going on during a code since there isn't much stress or excitment. Our code team has worked very hard training staff to respond appropiatly. There is usally a mock code some place in the hospital every shift. By the time a med-surg RN faces her first code on her own patient she has already gone through dozens of Sim Man simulations, ACLS, several mock codes, and attended a real code or two during her stint on the code team (madatory for new hires).
  10. Visit  tothc2 profile page
    0
    Quote from IndiCRNA
    I work at the same hopsital and PMFB. I would guess he is already on sceen in about half of the codes. many times there are indications before the code that some thing is going wrong and the RRT RN is already on the case. He is right, our codes are calm and well run, no yelling or excitment is allowed. Even our tele nurses have to go to Sim Man lab and run code senerios. About the only time we have yelling and excitment at a code is if a code is called in a non clinical area, like the cafeteria. Pretty normal to hear low key off topic conversations going on during a code since there isn't much stress or excitment. Our code team has worked very hard training staff to respond appropiatly. There is usally a mock code some place in the hospital every shift. By the time a med-surg RN faces her first code on her own patient she has already gone through dozens of Sim Man simulations, ACLS, several mock codes, and attended a real code or two during her stint on the code team (madatory for new hires).
    Your med surg RNs take ACLS? And all nurses go to codes and simulations? You have to have meant something else here. Unless you are at an extremely small hospital. Even then, where's the money coming from for all of this? And maybe he can anticipate a code on a med surg floor if they go from one extreme to the next over a period of time. But in the ICU? There would have to be a rapid response nurse just hanging out in each of the ICUs in the hospital because there are MANY if not all patients on the verge of a code. Your hospital has a lot of resources and money.
    Last edit by tothc2 on Feb 4, '13
  11. Visit  IndiCRNA profile page
    1
    Your med surg RNs take ACLS?
    Naturaly.

    And all nurses go to codes and simulations? You have to have meant something else here. Unless you are at an extremely small hospital.
    Yes all new nurses, as part of the nurse residency, will spend time on the code team with an "orientee" badge on. All will go through the Sim Man lab initialy and then anually for refresher. Our hospital is fairly small, but at 580 beds I don't consider it extremely small.

    ven then, where's the money coming from for all of this?
    Dunno. Our hispital, like every one I have experienced, is always crying poor mouth and budget cuts, yet seems to have plenty of money to waste on silly ideas.

    And maybe he can anticipate a code on a med surg floor if they go from one extreme to the next over a period of time. But in the ICU?
    Yes but it's the ICUs. Those nurses are highly experienced and trained and take care of things themselves. Usually I just place a tube (if needed) and bug out. They have had everything well in hand.
    Due to the nature of our ICU patient population and our superb step down unit (means only the sickest of the sick are still in ICU or whould have been moved to the step down) codes are not ususual and the ICU staff well versed in dealing with them. As I have heard PMFB say when training nurses "Hey it's not YOU who is dead, why get all excited?".

    Your hospital has a lot of resources and money.
    Most hospitals do, despite their claims to the oppisit. I would bet than many nurses here have heard their hospital say there is no money for raises for nurses this year, only to see the hospital waste money doing something silly or stupid.
    PMFB-RN likes this.
  12. Visit  tothc2 profile page
    0
    Quote from IndiCRNA
    Naturaly.Yes all new nurses, as part of the nurse residency, will spend time on the code team with an "orientee" badge on. All will go through the Sim Man lab initialy and then anually for refresher. Our hospital is fairly small, but at 580 beds I don't consider it extremely small. Dunno. Our hispital, like every one I have experienced, is always crying poor mouth and budget cuts, yet seems to have plenty of money to waste on silly ideas. Yes but it's the ICUs. Those nurses are highly experienced and trained and take care of things themselves. Usually I just place a tube (if needed) and bug out. They have had everything well in hand.Due to the nature of our ICU patient population and our superb step down unit (means only the sickest of the sick are still in ICU or whould have been moved to the step down) codes are not ususual and the ICU staff well versed in dealing with them. As I have heard PMFB say when training nurses "Hey it's not YOU who is dead, why get all excited?". Most hospitals do, despite their claims to the oppisit. I would bet than many nurses here have heard their hospital say there is no money for raises for nurses this year, only to see the hospital waste money doing something silly or stupid.
    You say "naturally" like this is the norm. But it is not... All ICU nurses should have ACLS, the majority of step down RNs should, but I have never heard of med surg RNs having or being required to have ACLS. This is very strange and very much not the norm. At my hospital between the MICU, SICU, STICU, TICU, NICU, MSICU, CCU, CVICU, etc and all of their respective step downs, how there would be enough classes, money or time left for med surg nurses to get ACLS certification is beyond me. And if I were a med surg nurses not planning on going into critical care I wouldn't waste my time or money. And yes hospitals have a ton of money, but I'm saying when have they ever invested it into their nursing staff (to send all of them to sims, acls and code observations). Which from your post I see we agree on.
  13. Visit  gaonsi profile page
    0
    Quote from Dodongo

    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.
    Thank you for bringing that up tactfully! I was thinking the same exact thing. I hope this is a 1 in a million type situation. Just because its a code, it doesn't mean nurses can be careless. Even in the chaos of a code, we label our meds and use our drug mixing guide. Code carts have a bunch of different meds, so just because its a code, you don't double check our meds?! Scary ish. Epi wide open?! Scary.

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