Need Help & Opinions/Orientation Problem

  1. Hello all,
    I am orienting to ICU after being on an oncology/organ transplant floor for three years. I started in October and am supposed to be through with my 12 week orientation on Christmas Day. Up until now I have only had one course relevent to critical care, I did take the trauma core.
    For weeks I have been asking about the critical care course and a dysrhythmia course and my manager has been not giving me any solid answers. Last week he told me I may not be able to come off orientation until my classes are met in January. I was fine with that.
    HOWEVER, yesterday he informs me that I will not be attending the critical care course until Feb/March and he is still not sure about the dysrhythmia class. He basically tells me that I will be off orientation without these classes.
    What do you think? Do I have a right to fight it? Is it worth it, the classes I mean.
    My gut tells me that I shouldn't let him do this but I am not sure because I don't even know what the courses are like.
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  2. 19 Comments

  3. by   nrsang97
    I have too made the transition to the ICU after working on a medsurg floor. I was given 6 weeks of critical care classes. In the critical care class we had a dysrhythmia class. I had already had these since one medsurg floor I worked on had tele pts. I had already had ACLS also.

    I think your boss is giving you the short end of the stick if you don't have these classes. Tell him/her that you don't feel comfortable to go on your own until you have had these classes.

    In my hospital we aren't allowed to go out on our own unless we have passed the critical care class and their rhythm competency and resp competency. Good luck to you.
  4. by   cardiacRN2006
    We had a spot JCAHO inspection a few months back. My chart was the one chosen to be reviewed (what luck!). The JCAHO people questioned me about my restraint policy, care plans, and such. Then they specifically asked if I was ACLS certified and if I had taken a critical care course.

    You can't (check your P&Ps) work in an ICU without at least being ACLS certified. If one of your pts dies, and you don't have it, it's your behind that is on the line.
  5. by   aquaphoneRN
    Quote from LaurynRN
    I was fine with that.
    HOWEVER, yesterday he informs me that I will not be attending the critical care course until Feb/March and he is still not sure about the dysrhythmia class. He basically tells me that I will be off orientation without these classes.
    What do you think? Do I have a right to fight it? Is it worth it, the classes I mean.
    My gut tells me that I shouldn't let him do this but I am not sure because I don't even know what the courses are like.
    In my hospital, it would be a violation of union policy to come off orientation without completing the critical care courses. The manager would have a lot of explaining to do if they attempted this.

    You owe it to yourself and your patients to fight for this.
  6. by   LaurynRN
    Thanks for all your thoughts. I am so happy to hear about what others think
  7. by   ElizabethJRN
    Quote from cardiacRN2006
    You can't (check your P&Ps) work in an ICU without at least being ACLS certified. If one of your pts dies, and you don't have it, it's your behind that is on the line.
    Is this universal, or per hospital policy? I know you said check your policy and procedures, but I'm still curious. I've been on my own in our MICU for 6 months, and they won't let any new grads take ACLS until we've been on our own 6 months. (I take the class next week). They claim because we don't know anything yet. I think it's unsafe to work there without being ACLS certified. Does anyone know or have any links? I tried looking on the JCAHO
    site but found nothing. Thanks.
  8. by   Ruby Vee
    [font="comic sans ms"]to the original poster: do you know your rhythms? if so, i think the dysrhythmia class can wait. if not, no. you won't be a safe practitioner if you don't know what rhythm your patient is in, or note changes in their rhythm.

    as far as the acls classes -- some icus mandate being acls certified, others don't really care and some even discourage it. i think if you know your rhythms and your drugs, you're probably safe without it. it isn't as if you're ever going to be the only nurse around -- believe me, if your patient tanks you're going to have as much help as you can handle. i can understand waiting until you've been on the unit for 6 months -- it increases the chances of you actually passing! the important thing is that you recognize and are able to respond to changes in your patient's condition.
  9. by   bluesky
    Quote from cardiacRN2006
    We had a spot JCAHO inspection a few months back. My chart was the one chosen to be reviewed (what luck!). The JCAHO people questioned me about my restraint policy, care plans, and such. Then they specifically asked if I was ACLS certified and if I had taken a critical care course.

    You can't (check your P&Ps) work in an ICU without at least being ACLS certified. If one of your pts dies, and you don't have it, it's your behind that is on the line.

    Actually, you don't legally need ACLS to work ICU. The level 1 trauma center I worked at for 2 years did not. Most hospitals, however, do.
  10. by   bluesky
    To the OP;

    Now I don't know the details of your situation, however in your shoes I would sit down with the manager and lay it down point blank. You feel that you are ready to leave orientation in January and you want to know why you can't. THe class almost sounds like an excuse, *perhaps*. You may even offer to take an arrythmia class outside of the hospital... or buy a book, learn it on your own ( I recommend Dubin's book) and ask if you can test out of the arrythmia class. ACLS is a piece of cake. You could take the initiative and take it on your own (though it will cost you about $250 and it's hard to find on short notice). You could offer to take the BKAT.
  11. by   Christie RN2006
    At my unit (SICU), they require you to be ACLS certified within 12 months of being hired. Until you are ACLS certified you are not allowed to push meds during a code, or go on codes. They make you take CRRT classes before they let you care for a patient on CRRT. Before you go off of orientation, you have to complete and pass an EKG class.
  12. by   LaurynRN
    Ruby Vee,
    I do not know rhythms at all...which is the scariest part. I have taken an active role in learning them, I have been going over some and reading books on how to interpret.
  13. by   LaurynRN
    Bluesky,
    The class sounds like an excuse to who? An excuse for my manager to let me complete orientation or for me to stay on orientation?

    After I talked with my precptor she was appalled that my manager would ask me to be off orientation without the critical care course and dysrhythmia. My preceptor asked around to the senior nurses who are also just as shocked. What happens when I need to take my patient off the floor for CT and I can't ask anyone a question?
    Every nurse my preceptor and I have talked to (including charge nurses) said that it is outrageous. Basically it was my mangers responsibiity to enroll me in these classes and he dropped the ball. There are classes in Jan. but they are all full, which means that I didn't get in it.
    Some said that they can throw me over to Med/Surg until I can take all the classes I need.
    When I am in on Thursday my preceptor and I are going to talk with my manager and see what we can come up with.
    I feel like I am a competant nurse but this orientation just hasn't been enough. It really doesn't make much sense to me. Other nurses that came from ICU in other hospitals get 12 weeks, same as me. Then we have to sit in hospital orientation class for the first 2 weeks, then trauma class for a week, and if I were to have the other classes that would be another 2 weeks. That only leaves like 7 weeks of floor time, just not enough.
    My biggest concern is that if something did happen it would be my license on the line.
    Thanks again to all posters for your opinions.
  14. by   aquaphoneRN
    Every experienced nurse you tell this story to seems to have the same advice. That should tell you something.

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