PICU Nurses

[biscuit_007]

Any PICU nurses out here? Where do you work? How is your staffing? How many RN openings are on your unit? How do you like where you work?

Let's try to get a dialogue going about PICU issues!:roll

[picucrn]

I would be interested in hearing what steps you took as nurses to better the communication and overall relationship with the md's. At my facility we have one intensivist that we struggle with everyday. We have had a great unit for last several years until she came. She doesn't allow any autonomy and criticizes everything, even that which doesn't even involve her. We have had an extremely high turnover rate with people stating her as reason for leaving. We have talked to her about respect, but she just blows us off and doesn't think there is a problem with her.

[NotReady4PrimeTime, RN]

I think I've worked with her!

We're still working on building better collaboration with our physicians (we have 7 intensivists and four fellows!). Some of them are very good and will listen and explain when they don't agree then listen again while the nurse offers more input, others who shut things down without saying a word. But for us part of the issue is that we have a HUGE contingent of very inexperienced nurses who really don't know what they don't know, who don't undesrtand or recognize ominous changes in patients, and the physican group doesn't trust them. We oldtimers are given a lot of autonomy over certain things and none over others, and whenever there's been an incident with one of the newer nurses, we are all lambasted by our management, who sends out blanket "you're stupid" emails. I keep them in a file that someday I will find a way to use to improve things.

One thing that might help in our unit is that our medical management has made some changes. The intensivists will now be dividing up responsibility for the patients in the unit along cardiac and noncardiac lines. We always have two on during the day, so one will round on the cardiacs and the other will round on the rest, at the same time. The back-up intensivist will be the fire-putter-outer for the time rounds are in progress. They feel this model will accomplish several things... rounds will be over and done with before supper time :w00t:, the physicians will have more time to work directly with the nurses on improving patient care and more time to spend with the families and the plan of care will change less often. (Right now it might change every single shift... and isn't that a problem!) We'll have to see how it plays out; this is the first week it's been in practice and I'm on vacation so I have no idea if it's working or not.

Does your hospital have an official respect-in-the-workplace policy? You should be documenting incidents with your problem doc so that when there's enough evidence you can go to the medical director and human resources and file a formal complaint. Documentation has to be first-person and signed, but the identitie of the complainants will be kept confidential in most cases when the complaint is acted on. Best of luck...

[swiss brian]

i work in a combined neo-picu in st gallen, switzerland. we get everything here except for cardiac surgery, which goes to zurich. i only came to picu 2 years ago, and am also on a steep learning curve, but love the work and the atmosphere. we have the usual problems with staffing, finance, etc so you are not alone.

[jessPICURN]

I work in the PICU at Women's and Children's Hospital of Buffalo. We are a 20 bed (can flex to 22) multidisciplinary unit. We generally have adequate (or near adequate) staffing. We see a mix of medical, neuro, cardiac, and trauma, with some high-risk OB thrown in. Our kids range from days old to adult. (i think my oldest pt. to date was 45!) We have a fairly active ECMO program, and VERY active transport team.

[MachoNurse, BSN, RN]

I'm a nursing student and am hoping to do my preceptorship in the PICU at CHO. I volunteered in the ER prior to entering nursing school and loved the hospital! Coincidentally, I looked at moving to Portland prior to entering nursing school. Perhaps some day...

Take care,

Rob

[ArkieDonRN]

My name is Don. I work at Arkansas Children's Hospital in a 26 bed PICU. We also have a 31 bed CVICU and an 85 bed NICU. I have worked here for 1.5 years and love it. Being the only hospital for children in the state, we care for all acuity of pts. We have MDs 24 hrs a day and use a very Team-like approach in pt care. Our shifts are three 12 hr shifts per week, with self-scheduling and premium pay for extra shifts worked.

ACH was ranked in the Forbes Top 100 best places to work for in 2007 and 2008. Not many hospitals make the list. I LOVE IT.

[ndaewg, BSN, RN]

I am a student still. I chose the PICU for my capstone class, but unfortunately I didn't get it. I toured the PICU at Children's Mercy Hospital, in Kansas City and found it amazing. I just loved the atmosphere. Someday I hope to post here saying that I am working in a PICU somewhere. :)

[Smiler3]

Hey I work on PICU at a childrens hospital in Birmingham, England.

I work on a 20 bedded unit (can go up to 21 beds and in the consultation process of expanding to 28 beds!) We work Long Days, Early's, Late's and nights a mixture of all and we self roster. On each shift we should have a minimum of 25 nurses. At the moment we are also experiencing a quiet time which is very nice! I have worked here for nearly 2 years.

We have a good team of Intensivists and Dr's and work well as a team! We cover anything really majority cardiac patients, we also have a very active retrival team, we do ECLS and the usual...CVVH, Osolaitors, Nitric ect.

Really interesting reading about everyone else! x

[NotReady4PrimeTime, RN]

Hey Smiler! Long time no see. We need to chat... if I ever get my new computer sorted out.

Our unit is currently slowing down a bit, but it's not really noticeable. There was a rumour that we were going to close beds, but that isn't going to happen for real. Unlike our counterparts in Manitoba we aren't seeing many H1N1 flu cases...yet. Not looking forward to that.

[KayleighTravelNurse, RN]

How do you guys like PICU?

[babyrhine]

Hi Im Drina from Sabah, Malaysia. PICU with 6 beds at the Queen Elizabeth Hospital in Kota Kinabalu, Sabah, for the management of critical ill children. The number of staff working that time only 16 staff nurse. In 2005, Kota Kinabalu Sabah opened the first Sabah Women's and Children Hospital with 13 beds and 26 staff nurse.. We nurse 2 patient every shift (7 hours). We are tertiary referral centre and treat around 250 children a year from all over Sabah, often with very complex disorder. We work across specialties including respiratory, oncology, nephrology, neurology, cardiology and metabolic disorder. The services we provide include conventional ventilation, high frequency oscillation, Continue Renal Replacement therapy (CRRT) and Intensive Care Retrieval Service (CATS).

[babyrhine]

Hi, im Drina from Sabah Malaysia... l would like to know about ur place.. now im taking master on nursing science and will finish Jun next year.. i had 15 years experience in PICU.