Alright. So I just started a job at an LTAC hospital. I have only been there a couple of days now. I was told just yesterday, by a smiling unit clerk that I will eventually be placed in ICU to work sometimes. Um... I have only worked med/surg/telemetry. I have worked on Step-down ONCE in my 15 years as a nurse.
I have also been told that sometimes they place LPN's in their 6-bed ICU. Granted, the LPN's are good and knowledgeable, from what I hear, but still... ???
My concern is: sometimes they have patients back there on ventilators. I was told that "You just call the house supervisor or respiratory if you get in a bind." What??!?? I take pride in my job and I don't want to work in an area that puts my lic. at risk. No one will protect my lic. but ME!! I need advice on this please!!!
No. "First off" she needs to talk to someone other than the unit clerk and find out if it is indeed true, then determine what kind of orientation will be offered. The LTAC's in this area won't hire any nurse who doesn't already have ICU/CCU/NCCU experience and a full complement of life support certifications. It's difficult to believe that they are going to just throw a new nurse into the vents unit without at least giving her a little inservicing.
BTW, vents and ventilator patients are not as hard to work with as some of you portray.
Agree. A trach'd, vented patient is pretty much the textbook definition of an LTAC patient in my area. Otherwise they would be in an SNF.
Having said that, though, I agree that you should be given an adequate orientation. If your previous experience is post-partum, your new LTAC patient population is, on the whole, much sicker than you're used to. A good approach to take with your preceptor and/or supervisor might be, "I want to make sure I have adquate exposure to as many different patient presentations as I can while I am on orientation" ... rather than fixating on one piece of equipment as something you can't handle.
My background is med/surg/telemetry, not post partum. I worked post partum a few times, but would prefer NOT to palpate a fundus and determine if it is boggy or not since I have been med/surg/tele for 15 years. I don't mind new experiences but I would PREFER my patients be confident in their nurse rather than have ME take take of them when I am not comfortable. I will talk to my supervisor about the orientation process. My friend who talked me into going to work at this LTAC basically said the same as you did, TakeOne... that they are not as hard to handle as you would think. I guess it IS fear of the unknown... She said the R.T. has your back really well in the LTAC and that there would be another experienced person RIGHT THERE next to me and that I didn't have to take care of a person I wasn't comfortable with... she said that like 3 times in her email to me moments ago. So... I feel better about it, overall. Mainly, it was liability AND the worry of (ahem!) KILLING someone .
I also work in an LTAC and while I haven't been floated to high obs (they're term for ICU) there are vented pts on the floor. I know in the LTAC I'm in the RT's are highly qualified and do the majority of respiratory care for these pts. I normally work the med surg unit but was floated down to another unit and had 4 vented pts. Was I uneasy? Of course but it wasn't something I couldn't handle, I fully utilized the charge and she was fully aware that I was new to work on that unit.
I wouldn't get all freaked out by what the US is telling you, it sounds like she like to stir things up a bit. I would cross that bridge when you get to it. It sounds like maybe you should follow your chain of command and speak with your NM about your concerns instead
of going straight to the BON (and telling co-workers).
It's not a nurses job to maintain the airway, it's the resp therapist job. Hence they do the vent changes, place pt on trach collars. If u maintain the airway then u'd be a crna or apn. Ask for a few orientation shifts, one would think that management would already have it planned but not always. Good luck
It's not a nurses job to maintain the airway, it's the resp therapist job. Hence they do the vent changes, place pt on trach collars. If u maintain the airway then u'd be a crna or apn. Ask for a few orientation shifts, one would think that management would already have it planned but not always. Good luck
And RT is always there? Not in my world.
It's the nurse's job to maintain the airway. RT comes when you call them. Otherwise, the nurse is there/on the job/responsible.
I also work in an LTAC and while I haven't been floated to high obs (they're term for ICU) there are vented pts on the floor. I know in the LTAC I'm in the RT's are highly qualified and do the majority of respiratory care for these pts. I normally work the med surg unit but was floated down to another unit and had 4 vented pts. Was I uneasy? Of course but it wasn't something I couldn't handle, I fully utilized the charge and she was fully aware that I was new to work on that unit.
I wouldn't get all freaked out by what the US is telling you, it sounds like she like to stir things up a bit. I would cross that bridge when you get to it. It sounds like maybe you should follow your chain of command and speak with your NM about your concerns instead
of going straight to the BON (and telling co-workers).
I would also like to add, that the vent is the least of your problems if you also have to titrate drips. An insulin drip is not the only drip you will have to titrate. I mean, pressors, like Dopamine, Dobutamine, Levophed, Nipride, etc. It is not just going up or on the rate. You HAVE to have an understanding of the hemodynamics involved in working with them. That takes quite a while to fully understand what you are doing, and why. You can KILL someone in and instant, if you don't know what to do.
That is the reason that LPNs don't work in ICU. The moral of the story is, just say NO!!
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I accepted assignments in PICU and NICU as a float LVN a few times, but the patients were just ready to be moved to a less acute unit, the one I normally worked in. Both had excellent managers. However, looking back I can see it was risky as I had no formal orientation to those units and if their condition went from stable to unstable in a hurry I didn't have the comprehensive background knowledge to intervene in a timely manner. It really disturbs me that these places seem to care more about having all the spaces on their Bingo card filled (staffing) than they do about the welfare of the patient and the nurse's license. They will not advocate for either, so I guess again it's up to us.
I had a job once where the secretary told me where my parking spot was. An hour later, a very irate man came in with my boss. He then proceeded to turn totally red and demand that I instantly move my car. The secretary heard and saw this. She should have taken the blame but did not. I know she did this on purpose from the look on her face and because later on I heard her and another worker discussing it and busting a gut with laughter about it. I never called her on it. But I never forgot it, either.
Get my drift?
This secretary loved to be the bearer of bad news and of criticism, not only with me but with a number of us. A year later, when I was back in school, I got her to type up a couple of papers for me - for free.
If you allow them to put you in ICU without adequate orientation, well, just don't. It sounds like you'd be the only nurse there. Or the only RN. Is that so?
Sorry if this was already asked, I just haven't read through all of the comments yet.
You said this is LTAC, what is the acuity of the patients in your ICU? Being long term patients, I'm guessing they are much more stable than hospital ICU patients? I wouldn't think they would send someone to LTAC if they needed titrated drips. But I don't know much about what LTAC will/will not take. Although I agree it takes special orientation and training to work in any ICU.
I will talk to my supervisor about the orientation process. My friend who talked me into going to work at this LTAC basically said the same as you did, TakeOne... that they are not as hard to handle as you would think. I guess it IS fear of the unknown... She said the R.T. has your back really well in the LTAC and that there would be another experienced person RIGHT THERE next to me and that I didn't have to take care of a person I wasn't comfortable with... she said that like 3 times in her email to me moments ago. So... I feel better about it, overall. Mainly, it was liability AND the worry of (ahem!) KILLING someone . 
:lol2:
Altra, BSN, RN
6,255 Posts
Agree. A trach'd, vented patient is pretty much the textbook definition of an LTAC patient in my area. Otherwise they would be in an SNF.
Having said that, though, I agree that you should be given an adequate orientation. If your previous experience is post-partum, your new LTAC patient population is, on the whole, much sicker than you're used to. A good approach to take with your preceptor and/or supervisor might be, "I want to make sure I have adquate exposure to as many different patient presentations as I can while I am on orientation" ... rather than fixating on one piece of equipment as something you can't handle.