Quote from dirtyhippiegirl
Lots of politics in PICU, too. No offense guys but I kind of feel like our PICU nurses tend to hold on to patients who could be downgraded to peds or even moved to an adult floor (that 60 kg seventeen year-old) -- because they WERE so sick, and staff has gotten attached to them. Which would be okay but those patients are always the first to be suddenly transferred to OUR unit when PICU gets a legit admit. Usually ****** off the parents and the patient.
You're right, but it's not usually (just) because we like them. It's also because we KNOW them. If they were so sick, they likely have potential to get that sick again if they develop some sort of complication. There have been many times we've transferred to the floor only to have the kid bounce back the next day due to slight deterioration. We recently had a child (10 month old, heme-onc patient, septic shock, pneumos, chest tubes, intubated, pressors, the works) who was finally stable and ready for transfer. Floor didn't have a bed, so we kept him. The next day the nurse noted that he was more tachypneic than usual (50's-60's). Did an x-ray and low-and-behold he had another pneumo.
We have lower ratios in the PICU. We have monitors and the ability to take vitals more frequently (done q 4 hours on the floor) and assess more frequently for changes in status. Had this kid been on the floor, there's no telling when his pneumo would have been noticed. They have 5-6 patients each compared to our 2. They have nursing techs who take vitals. They don't have monitors that can tell them their patient's RR and SpO2 at a glance.
We keep these kids because, while stable
they are also fragile.
As they have just recovered from an illness, they have the potential to deteriorate quickly and often with few or subtle preceding changes in condition.