An ICU With No Techs

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Have any of you ever worked in an ICU without techs. I do, and I can assure you it is no picnic. Apparently, techs were abolished by management before my time; I am not sure of the original reasons, and we have never been successful in bringing them back, although we bring up the issue at each staff meeting.

I have worked in this small city ICU/CCU for two years. Our patients are mostly medical, and some of them are very sick. We have two patients per nurse. And we do everything--hourly vital signs, fingersticks, daily weights, clean poo poo poo, wound care, regular critical care nursing care duties, obviously, linen changes, feeding patients, bringing drinks for family members, (of course) and often, physical therapy and swallowing evals (while we are waiting for these departments to come, sometimes days--or the intern/resident forgets to order these consults until we, or the intensivist, remind him to). Sometimes, there is so much poo to clean that meds get given very late and tests get delayed. Often, one patient has to lie in poo while his nurse cleans her other patient.

It is exhausting. Most of the time, we are short staffed, as our managers will not hire new staff due to the economy. If a patient refuses their bath on night shift, or the night nurses do not have time to get to it, the day nurses are simply not able to get to it, either. We are not assured of a secretary, either, and some of the ones we have don't do their job at a correct pace, either. We are expected to assume secretary duties if the secretary is absent or neglectful. This includes answering phones, showing visitors back, taking off orders, putting them in the computer, and updating kardexes.

It would be nice to hear if we are alone in this, or if there are other ICU/CCUs without techs.

Any suggestions for accomplishing change? Thoughts? Ideas?

The only possible advantage I can see is that we sure know what's going on with our patients--if we get into both their rooms often enough.

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Specializes in Telemetry, CCU.

Our ICU and CCU are like that at times; we have 2 techs on day shift (they are never scheduled on the same day) and 1 tech on night shift (who works 3 days a week so that leaves 4 days/wk without a tech, and sometimes the techs get called off). We share 1 tech between our 2 units, 10 beds each unit, so you can imagine they get stretched pretty thin. Our techs not only do basic care but are also certified phlebotomists so they do accuchecks and peripheral blood draws, which is very helpful at times but can also lower the poo poo cleaning on the priority list.

On day shift, they are supposed to have a secretary for 8 hrs of the shift but I think she only works M-F so the weekends can be hectic. And we have no secretary on nights which usually isn't a problem but it can be crazy when we get a bunch of admits or a pt has a lot of new orders d/t crash and burning. Then you have a few docs who like to come in at 6, right before shift change and write a ton of orders so that can be a pain in the rear.

Just this past weekend I wanted to pull my hair out because I had such a heavy assignment and would have loved to have an aide, but even with our 1 aide its not a whole lotta help. I'm lucky the nurses I work with all understand and care about the pts because we depend on each other a lot.

As far as changing the situation, the only thing you can do, which I do, is Incident Report everything you can to show the higher ups that if you had better staffing you may not have as many mistakes happening. Good luck and keep your chin up; I feel your frustration :(

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Specializes in SICU, CCU, MCU, peds, physician's office.

There are no techs in the CCU where I work either. We do have a secretary most of the time, but she spends most of her time goofing off. She has been there forever and that is not going to change. Luckily, the nurses work great as a team and help each other out the best they can. We do everything for our patients, including EKGs, lab draws, and tele monitoring. It can be difficult to manage at times. We have repeatedly asked for a tech, but management says in order to do that we would have to lose a nurse. That is simply unacceptable in my eyes. I would rather do "tech work" than lose a nurse and have to take a third patient.

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Specializes in Cardiology.

Our CVICU has one tech, he works 4 days a week from 4am-2pm. He has no patient care responsibilities (does no accuchecks or call-light answering) but is responsible for our supply room and equipment, such as cables, IABPs, aquaphoresis machines, etc. He helps us with turns, getting patients out of bed, road trips to CT, and transfers to the telemetry floor.

I love our set-up with our tech and I wouldnt want it any differently. The fact that he's available to help us when we really need him (and not doing simple accuchecks) makes things so much easier for us nurses. But, on the other hand, when he has a day off, we all notice how much we miss having him on the unit :) He's amazing

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As far as changing the situation, the only thing you can do, which I do, is Incident Report everything you can to show the higher ups that if you had better staffing you may not have as many mistakes happening. Good luck and keep your chin up; I feel your frustration :(

Thank you for your comisseration. I agree with you that even one tech would not change matters greatly. How would you suggest writing up matters (incident reports) without creating an atmosphere of blame and harming the reputations of my co-workers and myself? It seems like a good idea, but I have little experience with incident reports as I rarely write up matters except if there was patient harm or good possibility of patient harm.

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There are no techs in my ICU either. They were done away with a few years ago. There is a secretary but only on weekdays until 6pm.

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I've worked in 2 ICU/CCU's without techs. The 1st one (long ago) was small and only had 6 beds. Therefore, we did everything, including secretary work, tech duties, drawing blood, administering respiratory treatments when respiratory wasn't able, etc...even trash duty and some housekeeping if you can believe it! This is not to say we had easy patients either...acuity was 2:1, sometimes 1:1, including post MI with complications, vents, DKA,s, swan ganz lines, etc...

The second one had 12 beds. NO tech and secretary only on day shift. We were not only responsible for the ICU patients total care and rhythm monitoring and interpretation, we also had to be responsible for monitoring the 12 patients on telemetry units on the medical/surgical floors. To be honest, I liked it this way, as I preferred to always know what my patients rhythm was doing, and not rely on the tech to tell me when something was wrong. Just my opinion.

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Specializes in Critical Care.

We rarely have a tech in our ICU. When we do, they basically do nothing but vital signs on downgraded patients and blood sugars. Occasionally we have a good one (typically a nursing student) that does more and proactively makes the unit operate better.

I can only dream of such a standard.

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now, I'm a bit confused...is this post talking about CNA/techs or the telemetry monitoring techs. The telemetry tech do only monitoring.

In any case, I've worked with neither. There are no specialty units that I have seen that have CNA/techs, except in Labor and Delivery. Of course, that's not to say that they don't exist in ICU, PICU or NICU. Just that I haven't seen them.

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Specializes in Telemetry, CCU.
Thank you for your comisseration. I agree with you that even one tech would not change matters greatly. How would you suggest writing up matters (incident reports) without creating an atmosphere of blame and harming the reputations of my co-workers and myself? It seems like a good idea, but I have little experience with incident reports as I rarely write up matters except if there was patient harm or good possibility of patient harm.

I guess it just depends on how you do it in your facility. At my job, we are supposed to write up late meds, pt falls, missed or not-noted orders (like a now order that took all day to get done), labs that were missed or not addressed, things like that. Those things are all preventable and even more so with good staffing. We use a computer IR system that goes directly to administration. There is ample room to comment on what the situation was, the outcome, etc.

I think in your situation, if you just stick to the facts and don't set out to have a personal vendetta on someone then you'll be okay. Heck, I've even written up myself a few times and wouldn't be upset if someone had a good legitimate reason to do so for a mistake I made; hopefully your coworkers will understand, especially since you all have the same goal (to get more help).

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Nope, no CNA/MA in a busy SICU.

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I've worked in 2 ICU/CCU's without techs. The 1st one (long ago) was small and only had 6 beds. Therefore, we did everything, including secretary work, tech duties, drawing blood, administering respiratory treatments when respiratory wasn't able, etc...even trash duty and some housekeeping if you can believe it! This is not to say we had easy patients either...acuity was 2:1, sometimes 1:1, including post MI with complications, vents, DKA,s, swan ganz lines, etc...

The second one had 12 beds. NO tech and secretary only on day shift. We were not only responsible for the ICU patients total care and rhythm monitoring and interpretation, we also had to be responsible for monitoring the 12 patients on telemetry units on the medical/surgical floors. To be honest, I liked it this way, as I preferred to always know what my patients rhythm was doing, and not rely on the tech to tell me when something was wrong. Just my opinion.

Our ICU/CCU has 17 beds and is divided into two sides, the ICU and the CCU. This makes the secretary situation more difficult, as when we have one, one side is also neglected. But the bottom line seems we are not alone, others are working under tech-less condtions. It is nice to know what is going on with your own patient, (how their backside looks, what their hourly fingersticks are, ect.) It's just been exhausting lately, and I'm fairly speedy and well-organized (not a newbie). Those who are less organized routinely stay 1-2 hours late to chart. (ouch). I used to always get out on time, but lately I have found that I have to stay 15 min.-1/2 hour. Not bad, though, compared with the others.

Cardiac rhythms, by the way, we would always monitor ourselves. No tech would be entrusted with that work. There are telemetry techs only on the telemetry floor in our hospital.

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