Ancillary staff in PICU..do you use them?

Pediatric Critical Care Columnist · Oct 19, 2007

Our PICU has nursing assistants, but they aren't allowed to do any direct care. Which is a crime in my mind. They should be allowed to work to their full scope. I think our burn unit may have some that do help with dressings. We only get the burns that are unstable and require intubation; the staff from the burn unit comes over to do the dressings every day but they don't announce what their professional designation is when they arrive. I'll ask around for you.

dianacs · Oct 19, 2007

Our PICU has nursing assistants, but they aren't allowed to do any direct care. Which is a crime in my mind. They should be allowed to work to their full scope. I think our burn unit may have some that do help with dressings. We only get the burns that are unstable and require intubation; the staff from the burn unit comes over to do the dressings every day but they don't announce what their professional designation is when they arrive. I'll ask around for you.

Curious to know...if your facility has a burn unit, why don't they take the unstable burns???

marilynmom, LPN, NP · Oct 22, 2007

I am a tech in the PICU. I'm a senior nursing student and I plan to stay there after I graduate. Where I work I am called a Nurse Partner and it is kinda set up like a preceptorship...so we are basically there to learn and help out. I love it.

We are expected to be very hands on with the patients. I am assigned to one RN (but I do help all the RN's if I am needed, but I'm usually just with the 1 RN for my 12 hour shift). I help with admits, VS, blood draws (I can draw blood out of all existing lines including art lines), foleys, ETT suctioning, I&Os, I can put in IVs, FSBS, central line dressing changes, I can do most things I have been checked off at school to do (no meds). I also do my own head to toe assessments alongside the RN and listen to heart sounds, neuro checks, etc. That way I'm getting some awesome experience as well as helping the RNs.

vamedic4, EMT-P · Oct 28, 2007

I am a tech in the PICU. I'm a senior nursing student and I plan to stay there after I graduate. Where I work I am called a Nurse Partner and it is kinda set up like a preceptorship...so we are basically there to learn and help out. I love it.
We are expected to be very hands on with the patients. I am assigned to one RN (but I do help all the RN's if I am needed, but I'm usually just with the 1 RN for my 12 hour shift). I help with admits, VS, blood draws (I can draw blood out of all existing lines including art lines), foleys, ETT suctioning, I&Os, central line dressing changes, I can do most things I have been checked off at school to do (except meds or IVs). I also do my own head to toe assessments alongside the RN and listen to heart sounds, neuro checks, etc. That way I'm getting some awesome experience as well as noticing things for the RN I'm with.

My job is similar to marilynmom's with slight variations...and I think it's a crime that other places don't have such programs in place. It helps the non nurse to see exactly what's involved, to feel involved in the care of the patient, to help the nurse out when she's only got 2 hands but needs 5...all the while learning what it takes to be a PICU (or med surg, or ortho) nurse.

mark2climb · Oct 31, 2007

When I worked in a PICU in Dallas as a nursing student, I worked along side paramedics. We acted as RN extenders and did more time consuming tasks like dressing changes, IV placements, and bed changes. Our paramedics also helped with bedside procedures like staying sterile and handing instruments for CT insertions and CVL placements. That way, the bedside RN is free to chart and give meds. It allowed the RNs to take busier patients. The nurse extenders all wore pagers as well.

MistyBlue · Nov 2, 2007

Our techs basically were assistant secretaries. They were not involved in direct patient care. They filled the supply carts, made sure that the charts had order sheets and blank progress notes. They would place orders in the computer, run specimens to the lab and get formula from the formula room.

picurn94 · Nov 2, 2007

I work in a PICU in NC and have worked in this unit for the past 14 years or so. We have always used a Support Partner that helps with stocking rooms, ordering supplies, etc but they do not perform patient care. We have used them as "sitters" for our suicidal 1:1 patients but it is not in their job description to perform direct patient care. We have Care Partners (Nursing Assistants) that are in a supplemental pool that intermittently work in the PICU. We love our Care Partners. They perform direct patient care, bathing, feeding, VS, etc. which is very helpful on those extremely busy days. They also play a dual role helping stock rooms with supplies, setting up rooms for admissions, answering phones, and call bells.

Semele · Nov 9, 2007

Our PICU is all RN staffed, but we do occasionally get NA or LPN help from the peds floor to come help with less critical pts when we are busy. They can feed babies etc.

WineCountryRN · Nov 18, 2007

Most interesting. We have student nurse externs and they do a lot of patient care and are assigned to a RN to precept them. Usually they all stay after graduation. We also have techs to do big dressing changes, stock supplies, clean the tub room, prep and clean up after major dressing changes. They are great at what they do, done it for long and come well prepared. I learned most of my wound care from them. I wish we did have an aid to feed babies at the PICU I am at. We have a lot of chronic kids and with a 1:3 ratio (they are trached), there isn't much time for social stuff, daily baths, etc.

thanks for the post.

SS

HazelLPN, LPN · Jan 21, 2008

We have several types of ancillary staff.

We have one nursing assistant (I) per shift. The NAI is either enrolled in nursing school or is a CNA. They peform duties such as stocking rooms, setting up for admissions, running erronds for the unit clerk or charge nurse. They are trained in basic patient care...often serve as an extra pair of hands when a patient needs to go off the unit to CT or MRI. They are assigned to the charge nurse and generally help anyone out who needs it.

We sometimes also have one nursing assistant II or nursing technician per shift. The NA IIs are nursing students enrolled in registered nursing programs who have completed either peds or have had a critical care rotation. The NTs are graduates of a nursing program who have yet to take their boards or who need to re take them. The NAII/NT is assigned to an RN and they do what we call "PIP" which stands for Partners in Practice. Most of our kids are on 1:2 care, a PIP team will take three patients on 1:2 care or on occasion they have taken a 1:1 and 1:2 or 1:3. The NAII/NT can assess under the direction of an RN, do dressing changes (though none around central lines), give ng/og feeds after the RN has checked placement, and can assist with ETT suctioning if the RN is present and helping. NAIIs/NTs can not give any medication, but they can re set pumps if the RN is directly supervising them. Its an excellent way to get ones feet wet in critical care. Most take positions RN positions in the unit as soon as they graduate and pass their boards. If an RN or LPN is mandated to float to the PICU from the floors, they usually are put on a PIP team with an RN and fuction as an NAII/NT unless they feel comfortable working on their own...and even then they are given a lot of help by the rest of the staff.

Always one unit assistant (formerley unit clerk) per shift. They are cross trained to assist with basic patient care, but most of the time are too busy with order/phones/putting out fires to help out that often. On nights they sometimes help with baths and weights when not busy....or serve as an extra pair of hands when needed. Many are pre-med students or nursing students and go on to bigger and better things once they graduate. One young man is now a pediatrician....and other young woman became an LPN in the unit.

We also have three LPNs in the unit, which are not considered ancillary staff but part of the nursing staff. In my state and hospital, LPNs are allowed a full scope of practice...we can do IV meds, hang blood, titrate our own pressors, take physician orders, draw gases etc. We do not do the initial assessment and therefore do not take new admissions. We also must check many IVP meds with an RN before administering them.....the same with blood products. The charge nurse never takes a patient assignment, and is resonsible for covering us if something comes up not covered under our license. We do not delegate to nursing assistants and never have a PIP team. We also do not initiate a care plan and serve as the patients care manager, though we help with the process by giving suggestions. We also do not train as ECMO techs, and very rarely help with the care of ECMO patients....if the kid is 2:1..two nurses and a tech.....they will sometimes use us as the second nurse.

I've seen so many models of nursing in the ICU come and go during time. This one seems to work the best. We need good future critical care nurses....and let's face it....you don't learn critical care in school unless you do an internship. PIP is something similar to what I did back in the dark ages in nursing school....where you pretty much worked with another nurse one on one...and when you earned you diploma you knew your stuff and could work anywhere in the hospital. It was mentoring....something we have gotten away from these days. Like I always tell young people in school...you really learn your stuff by doing....not by reading about it in a book.

PIVputterinner · May 1, 2008

We use techs but they don't do much patient care, they help the RN bathe, change beds, transport, and they do finger stick labs. But mostly they stock the bedside, run to blood bank or pharmacy, and sometimes if we have a baby that is well enough to take a bottle, they can feed them. We also have clerks that take care of the charts and phones. :nuke: