So I'm a few weeks in to my first assignment at a teaching hospital in Connecticut and noticing a few weird restrictions to my normal freedoms. At this hospital the ICU nurse has a guideline to how much/fast they are able to titrate the drips, not just a low amount and a high amount to stay between. They also can't do anything without an order, including EKG's, CBC's, ABG's, CXR's for ETT placement, etc. These are all minor things that were expected for you to know how to do and be proactive for the patient at my previous ICU. Of course you would let a physician know of the results within a a reasonable time especially if it showed something relevant but never did you go crawling for permission for an EKG beforehand if you noticed an irregular rhythm.
Also there are no standing orders here for cardiac morphine, starting a neo drip for hypotension, nitro for HTN, Amio for arrythmia's, NOTHING. Anything you need you have to get an MD on the phone or here in person, they assess them, then they personally put in the order, then pharmacy has to update the profile and THEN you can administer it. You just hope the patient hasn't declined too much or passed through the process! They also do not let Med Surg RN's put in NG tubes at this hospital, an ICU nurse has to go do it.... and this is just a few things that are weird to me.
My question is has anybody else noticed this kind of restricted behavior in ICU's across the country. I've caught myself nearly getting in trouble because I'm doing things I'm trained to naturally do for a patient but here they restrict it to MD only. I'd like to avoid states in the future with this kind of neutered restrictions. Any heads up of places like this?
Foleys, yes! IVs no. Not one since nursing school. I could probably make a stab at it, pun intended, but I don't think it would be appropriate (not necessary either generally with anesthesia providers ever present). A pediatric OR nurse on the other hand do a lot of IVs while the patient is gassed down.
Perhaps IVs are a poor example, with nurses in many practice settings and with lots of hospitals having IV teams. No doubt every specialty has core skills that would be better examples. Five rights perhaps.
Foleys are much harder than they look, and I don't think I've ever seen anyone else do one with good technique, especially urologists: docs always think ABX covers a multitude of sins. No wonder catheters account for a large percentage of hospital acquired infections. I stopped clinical practice for a full year, and it was no problem to insert Foleys again and do it perfectly first time. Anecdotal perhaps, but I think it is just a question of confidence (not chutzpah). Unfortunately, lots of people in every profession are lacking self confidence. They project their own issues on others. It was definitely more challenging to get an assignment after so long out because managers doubted my skills.
NedRN
1 Article; 5,785 Posts
Foleys, yes! IVs no. Not one since nursing school. I could probably make a stab at it, pun intended, but I don't think it would be appropriate (not necessary either generally with anesthesia providers ever present). A pediatric OR nurse on the other hand do a lot of IVs while the patient is gassed down.
Perhaps IVs are a poor example, with nurses in many practice settings and with lots of hospitals having IV teams. No doubt every specialty has core skills that would be better examples. Five rights perhaps.
Foleys are much harder than they look, and I don't think I've ever seen anyone else do one with good technique, especially urologists: docs always think ABX covers a multitude of sins. No wonder catheters account for a large percentage of hospital acquired infections. I stopped clinical practice for a full year, and it was no problem to insert Foleys again and do it perfectly first time. Anecdotal perhaps, but I think it is just a question of confidence (not chutzpah). Unfortunately, lots of people in every profession are lacking self confidence. They project their own issues on others. It was definitely more challenging to get an assignment after so long out because managers doubted my skills.