A fellow ICU nurse needs some assistance!

may2kd · Nov 18, 2008

the survey: k.m.

years in nursing_3.5__ years in critical care 2.5

what does the "culture" of critical care nursing mean to you personally?

i think the culture of critical-care nursing is fast-paced with moments of extreme slow, and you have to be able to handle both. i think it encompasses the best of nursing---caring for loved ones while utilizing science and evidence based practice. it takes a skill level and a mind set that not every nurse has.

in your opinion, what do you think are the barriers to open communication in this profession?

i think the worst barrier comes when doctors don't realize how intricate a role nurses play in the care of the patients. that we're not "just the nurse", or handmaidens, that we actually do know things. we learn more in 6 months in an icu than they do their entire 4 years of medical school.

what do you think could be done to improve communication between staff, physicians and families?

i think it depends on the atmosphere and the level of education of the families. there are still a lot of people out there that look to the doctor for everything, that they are the be-all and end-all of healthcare. the public needs to better educated about the role of the np, crna, etc and then they may look at the staff nurse as more than the person getting their father some ice chips. also, physcians need to treat nurses with more respect. i think an open communication is key. families need to be able to ask questions without having physicians directly influencing their decisions-- i mean as joe friday says "just the facts, m'am". no false hope, no miracles could happen. if there's a 10% chance of recovery families need to hear that. i think that hinders communication.

do you consider the icu to be a "high-stress" environment? why or why not?

it is a high-stress environment, but i enjoy it. it's a place where life and death decisions actually are made. you and a team doctors are helping to decide the fate of your patients. with that said, it's also an awesome place to work, and i wouldn't work anywhere else as a staff nurse. i enjoy having 1-2 patients where i can spend my entire 12 hours reading the chart, and knowing the patient in and out. you can't get that involved on the floor. if you aren't good with stress, than it's not going to be a good fit.

do you ever feel "burnt-out"? have you ever considered leaving the nursing profession due to stress or behaviors exhibited by others?

i've only been a nurse for 3+ years, but i've never felt burnt-out. i've felt bored and because of that my work has suffered. i love everything about icu nursing. i have been accepted to crna school in the fall, so i'll be leaving bedside nursing, but not because i didn't love it. i love the icu.

hey, good luck with your paper. hope this makes sense and it's ok!

MelRN13 · Nov 18, 2008

Thanks for responding! It really means alot to me, and I really cannot express how much I appreciate your help!:nuke:

bellehill, RN · Nov 19, 2008

hello all, it's been a very long time since i've posted on this website, but i'm in need of some help.
to start off, my name is melissa, and i've worked in critical care for the last 5 years. i'm currently finishing my bsn, and need some help with a paper.
i'm looking for a couple of fellow rns to fill out a survey. the only personal info i need to know is your name (first initial and last name would be fine, or you can use an alias), what type of unit you work in, and how many years you've been in nursing. the rest of the survey is below. if you would feel more comfortable contacting me by email, please let me know.
thanks in advance!
the survey: m.h.
years in nursing_7_______ years in critical care __4______
what does the “culture” of critical care nursing mean to you personally?
dealing with a fast-paced work environment where every decision can affect a life (negatively or positively). helping the family members of our patients understand what is happening and teaching them along with the patient. collaborating with many different departments to deliver the best care for our patients.
in your opinion, what do you think are the barriers to open communication in this profession?
the negative relationship that exists between physicians and nurses creates a huge barrier to communication and sometimes patient care. nurses are looking for more autonomy while physicians are reluctant to give up control over the patients. stress is another barrier, especially between nurses and shifts. stress can cause gossip and disruptive behavior between peers which will negatively affect the flow of communication.
what do you think could be done to improve communication between staff, physicians and families?
one thing my unit has implemented is a morning update call to every patient's family member. we call in the morning to tell them what happened during the night and what the plan is for the day. we can also pass along any questions they might have for the doctors. we also have open visitation which makes it easier for the family to see the doctors and interact with the nurses. i think it is always important for the nurse to encourage the doctor to talk to the family and call them if the situation warrants a call.
do you consider the icu to be a “high-stress” environment? why or why not?
i think i answered this in the first question; our decisions and judgment affect people's lives. if i am having a bad shift or feel tired i might miss something that has the potential to cause harm. our patients are the sickest in the hospital. many times we work short staffed but still need to provide excellent patient care. we have family members who are stressed and doctors who are stressed.
another form of stress if the compassion-stress. working in an icu is emotionally and mentally stressful. dealing with live-or-death situations every shift can become difficult to deal with, especially with other stress present.
do you ever feel “burnt-out”? have you ever considered leaving the nursing profession due to stress or behaviors exhibited by others?
i have felt burnt-out many times, usually a vacation helps. i have considered leaving bedside nursing and participating in more of a behind-the-scenes role such as quality outcomes or research. the behaviors exhibited by others is also a factor although i try not to let it be. the lack of compassion and concern some nurses show to their patients is frustrating to say the least. i love nursing and helping people; i do not think i would every really leave nursing.

MelRN13 · Nov 20, 2008

Thanks to both of you very much. I greatly appreciate your feedback and help with my paper.

Thanks!

Melissa:nurse:

athena55, BSN, RN · Nov 28, 2008

name: a.t

years in nursing___33_ years in critical care _32.8__

what does the "culture" of critical care nursing mean to you personally?

well, culture in and of itself means a shared symbolic system of values, beliefs and attitudes that shape ones language, religion, rules of behaviour in a "society" or group/aggregate of actors....

being a critical care nurse means i must often act independently and use critical thinking/judgment/decision skills in caring and managing a person who may be close to death and in the next minute take care of someone who is recovering from a "simple" appy; oftentimes high paced, high pressure and sometimes very routine [unlike my brethren who work in the emergency department....now working there i find extremely stressful!]

in your opinion, what do you think are the barriers to open communication in this profession?

well, i can't speak for everyone...but i guess i am used to working collaboratively with the icu doc's (fellows, residents, interns). in my unit when medical/surgical rounds are being made the physicians will incorporate the "bedside" nurse and expect us to discuss patient care issues and actually follow through on any suggestions made by the rn. i think that is the biggest difference between working in a civilian hospital and an army medcen. there are differences in rank and there is a longstanding "culture" of respect. you won't find the drama here that you may find outside (civilian)

what do you think could be done to improve communication between staff, physicians and families?

again, working in an army medical center much, much different than working in a civilian hospital, so i guess i can't really answer that one

do you consider the icu to be a "high-stress" environment? why or why not?

yes. because of the responsibilities each member of the icu team has: not only must the rn manage the nursing care of this severely, critically injured or ill patient, but h/she must also deal with the multiple disciplines that are also caring for the patient and family members. keeping abreast of lab work and results, making sure replacements (electrolytes, blood products) are being ordered and infused, obtaining needed labs, cultures, placing peripheral or picc lines and maintaining them, administering the right med to the right patient at the right time via the right route....., keeping on top of any pain issues the patient may be experiencing, obtaining and documenting vitals, breath sounds, heart sounds, bowel sounds, q2h neuro assessment, making decisions about various drips the patient may be on depending on their hemodynamic status....at the same time you are dealing with family members, the phone ringing, a new admission or transfer, pharmacy calling about your missing vanco (as you try to remember what the level was), now your pa catheter seems to be stuck in "wedge".......the list can go on and on (as it often does)

do you ever feel "burnt-out"? have you ever considered leaving the nursing profession due to stress or behaviors exhibited by others?

no i may get tired, cranky and so happy for my one or two days off, but so far i have never thought about "leaving ". i believe that nursing is a "calling" [yeah, i am one of those old dinosaurs] it (being an rn) is what defines me as me. i am a nurse and a soldier.

good luck on your survey. it would be interesting to read of your results.:nuke:

athena

sweetsmiles10363 · Nov 28, 2008

The Survey:

Years in Nursing__1.5______Years in Critical Care __1.5______

What does the "culture" of critical care nursing mean to you personally?

when i think of 'culture' i think of the people i work with. I would not have survived if they had not been there and supported me. I love that i can ask any question and i'll get 6 different people answering with 6 different responses. I love that someone always has my back and that i never feel alone. this is very much in contrast with floor nursing (at least in my experience).

In your opinion, what do you thnk are the barriers to open communication in this profession?

for myself? simple apathy--i've tried to communicate with my managers before many times, and nothing was done. why try again? i'd rather just go somewhere else. I don't have too much of a problem communicating with the critical care MDs, just the hospitalists who like to get in over their head.

What do you think could be done to improve communication between staff, physicians and families?

having the physicians coming around at a set time so the families would know when they would be available for questions. if the public in general had a better understanding of the hospital (try educating them with something other than TV dramas).

Do you consider the ICU to be a "high-stress" environment? Why or why not?

YES!! i could have killed 3 different people last night and it wouldn't have been difficult. insulin drips, potassium, septic pts, the list goes on. plus, i work in the middle of tragedies--and being human, i can't help but be effected by that.

Do you ever feel "burnt-out"? Have you ever considered leaving the nursing profession due to stress or behaviors exhibited by others?

i feel burnt out right now. i'm already contemplating what i'm going to do when my contract is up (5 months). I'm burning out due to the stress of taking care of critically ill patients.

Indy, LPN, LVN · Dec 5, 2008

Thanks in advance!
The Survey:
Years in Nursing________ Years in Critical Care ________
What does the "culture" of critical care nursing mean to you personally?
In your opinion, what do you think are the barriers to open communication in this profession?
What do you think could be done to improve communication between staff, physicians and families?
Do you consider the ICU to be a "high-stress" environment? Why or why not?
Do you ever feel "burnt-out"? Have you ever considered leaving the nursing profession due to stress or behaviors exhibited by others?

Info: Lynette H., unit is a small-town ICU (6 beds and no specialty), been a nurse for 3 years.

On the culture of critical care: When I was a tele nurse, the ICU nurses seemed snotty because they didn't stop and talk on their breaks and whatnot. And when I did sheath pulling on their patients, some of them would try and leave me in the room with a nursing student, which made me want to scream. Hello sheath pulls can result in a code and I still got to have two hands jammed in that patient's groin yano? Now that I am an ICU nurse I think we're focused, and need to vent a lot (no that's not a pun), and always rethinking situations and comparing cases. Our particular unit has a "culture" consisting of coffee, coffee, and coffee. We live on it.

It's the stabilizing influence when we have neuro patients, cardiac patients, overdoses, psych patients, vent patients and god knows what else jammed in our little nuthole together. They get just as critical in the boondocks, and the ones who stay with us are too old or too poor to go anywhere else. (Yes I said it. You know it's true.)

On barriers to open communication:

Well. With patients and families, I can't communicate certain types of info that are outside my scope of practice: I don't dare predict outcomes, I can't interpret lab results that indicate diagnosis, etc. People think I'm gonna open up and give 'em info for their lawsuit but they are asking the wrong nurse. With other nurses, the barriers may be that we are both busy, or attitude, or language, or whatever. By language I mean that I have a pottymouth and am widely known for being blunt. Now I'm nice, but I'm not here to make other nurses feel good, and my opinion is that I should not have to mollycoddle people who are here to do the same job I am doing. The barrier is perception and understanding. People who don't understand my intent, and expect Miss Manners politeness embellished with a little buttkissing, perceive me as rude and mean and b!tchy. I, who don't understand having time to waste on buttkissing and silly stuff, and expect nothing less than good nursing care of of each nurse, perceive some folks as lazy or ditzy, and those are the good descriptions. Those same folks, who don't acutally see my sometimes excellent skills at de-escalating conflicts, spread the word amongst others that I'm an escalator of psych patients. You remember the disney movie "Aristocats"? Remember the little lady kitten saying "Ladies do not start fights, but they can FINISH them"? That's how I feel about certain folks that just can't be de-escalated, they need to be tied up and tubed, you might sedate 'em too.

Practical barriers include the fact that we are all overworked at some time or other, and a lot of us are hard of hearing, and/or in a hurry to communicate important info. We yell a lot and sometimes repeat ourselves.

On improving communication: Adequate staffing, which means whatever staffing grid the powers that be are using, they need to realize it's a crock of sh!t and add one more nurse to all the numbers, would help every single problem in the workplace. If you have time to do your job, you have time to talk like a human being and maybe walk to the desk to say something instead of yelling down the hallway. Facilities should pay for nurses and nurse aides' hearing aids. No really, they should. I know they won't.

I also think the culture of sensitive people entering the profession expecting to be treated like god's gift, needs to stop but I really don't know how to accomplish that. In my hospital they tend to run right back out the door, but not before they yammer and whine to my manager about how rude I am.

I think that physicians don't necessarily have to communicate better if I had hearing aids, 'cause I could hear the little softspoken foreign dude over the phone while the overdose is screaming at the top of his lungs... but if someone could teach them to write legibly and leave me a PRN med or two for sleep, agitation and pain for each admit it would also help. I would also like for all screaming fit-throwing patients to get a tube and sedation, but that'll happen when we get world peace and universal healthcare.

On whether ICU is high stress: YES. It's just as high stress as ER, OB, etc, just not in the same ways and not constantly. Your one patient can keep you busier than snot all night. Your patients are sometimes admitted in DNR status just so they can die, or not in DNR status because they are going to code and the doc is tired of having the ER bed tied up, or admitted for a silly thing like a cold and they wind up not breathing and you code 'em. Anything can and will happen. The one hallway out of the unit (wide enough to get a bed through) will suddenly be blocked by the visitor who just fell, cracked her head open and is retching, losing consciousness, etc. right at the moment you need to do an urgent transfer of a patient. In the daytime, higherups, even those who do your job occasionally, will always know some way it could have been done better.

On burnout: I felt it acutely after my first DIC patient that died. It had long-term effects on our small hospital and the community it serves. Just as I'm beginning to recover my sense that I want to be where I am, I realize that I've come out of the experience a bit ruder than before. Or that's what some folks think, anyhow.

I've had a great month, but it sure felt good to rant like that!

MelRN13 · Dec 10, 2008

:yeah:

Thank you all SOOOO much for your responses! I got an A on the paper, thanks to all of you.:heartbeat