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!!!
It has been clarified to me that I will be oriented, I do not HAVE TO work in there if I'm not comfy, I will ALWAYS have a back up person, Joint Commision came thru recently and is aware of LPNs working in there as they are experienced and the level of care of these ICU patients is NOT like that of a non-LTAC ICU: real big hospital. I am feeling less stressed. Respiratory therapy at this LTAC is amazing, as are the supervisors and other trained ICU staff, I'm told. So... There ya go. ;0)
Years ago, I was floated to ICU on FIRST day as an LPN! With no orientation, and was not even checked off to give meds yet! :eek: Ask to be orientated to the unit ahead of time, only accept pts you are comfortable with.
The whole worry about titrating drips and adjustings vents is for an entirely different kind of ICU. It sounds like the place you'll be going has people on vents that are the level of acuity that sometimes even get sent HOME on them, and not always with 24 hour nursing care. Family members have to be familiar and know how to do this stuff. If a family member can handle it, you can handle it.
It's fear of the unknown. We have floors that won't take a patient with a trach. I love trachs, they make it really obvious I've got an airway, and if I lose that one, I've got another two taped to the end of the bed ready to be popped into place. But I used to be really scared of them. "A trach? Nursing school made it sound so hard. When do I use saline and when do I use H2O2 and when do I use the pipe cleaner??? Ahhh!!!"
I've got to say, Brandon's right. Think of it as an opportunity. Expand your repertoire of skills! Everyone that's learned to do something at one point didn't know how to do it. Things are less intimidating if you just look at it as a challenge instead of a "OH NOS! THEY'RE GONNA TAKE MY LICENSE AWAY IF I LOOK AT THE PATIENT WRONG!!" We're nurses. We can rig together any kind of cockamamey thingamajig to make anything work. Is there really a piece of equipment or drug they could put in front of us that we couldn't learn?
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I guess I should have read the OP more carefully? I didn't know you could have an ICU in a LTAC! :-/ Aaaahhh!! Titrating drips!! Nooooo!! I take care of stable trach/vent HH patients now. Still think Brandon may have been right, but not for the right reasons.
Well Marie, thank you for posting this for us all to ponder. I am starting my first RN job in a couple of days. Fortunately, having done my last clinicals in the hospital / unit (ED) in the same place I will be working, I already know I love the org for which I will be working.
But if I ever decide to go somewhere else, the very *first* thing I will ask them about is their policy on floating and orientation! Thanks again for sharing!
Talk 2 ur supervisor at once. I float to different wards here in Oz, but I couldn't go to ICU because I'm not qualified. Don't u need a diploma or specialied training in that area? Ur being every wise protecting ur license, because management won't give a fig if something goes wrong - they will just blame u. Don't do it, unless ur going to lose ur job. And I would also tell them u expect A LOT of support if u have to do it. A challenge is one thing, but risking ur license and patients is another thing.
I worked in an LTAC and I saw stuff like that happen all the time. It would be nice if from their end it was an "embrace the challenge" type situation -- then they would provide a lot of orientation so you knew how to do your job well, and you could learn a new area of expertise as a nurse.
Unfortunately, from their point of view, the perspective is 'we need a warm body, hopefully with a pulse."
The vent aspect of the care is scary at first but with some training you will become used to it and it is not as scary as it looks. The other aspects of patient care in the ICU is another story entiely. And isn't six patients for two nurses a pretty heavy load? The place I worked the most they ever had was two patients per nurse.
I don't think you are out of line to go to your manager and say you don't feel qualified to do this without some orientation -- I did that once at a facility where I worked they were not happy but they knew I meant business so they did what I wanted. They didn't have any choices -- they were already short staffed.
Funny thing about that whole "warm body" thing is that they are putting you there because they are short staffed and losing you would put them in a real bind. So it is in their best interests to provide you with the tools to do your job -- although you of course, don't mention that in your discussion.
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 think you should explore it a little more before you freak out.
I occasionally float to ICU. I've never been oriented there, I'm a med/surg nurse. I've had a vent patient ONCE. There was an RT dedicated to the ICU, so she was there all the time, managing the vent. The charge nurse made sure I was oriented to the meds/titrations, etc, and was right there, available all the time for questions and help. Most of the time I float, they give me the least complex, most stable pts, and they always make sure I'm comfortable. I don't feel unsafe floating there at all.
Before you start reporting people or facilities to the BON or refusing assignments, definitely get all the info first.
try to embrace the challenge and learn something new
I don't think this person realizes how dangerous this could be, you don't just "learn" icu while you have a crashing patient, the drugs, drips, procedures and even certain scopes of nursing practice are very different and doing so would put these patients, as well as nurses license in extreme risk
The whole worry about titrating drips and adjustings vents is for an entirely different kind of ICU. It sounds like the place you'll be going has people on vents that are the level of acuity that sometimes even get sent HOME on them, and not always with 24 hour nursing care. Family members have to be familiar and know how to do this stuff. If a family member can handle it, you can handle it.
It's fear of the unknown. We have floors that won't take a patient with a trach. I love trachs, they make it really obvious I've got an airway, and if I lose that one, I've got another two taped to the end of the bed ready to be popped into place. But I used to be really scared of them. "A trach? Nursing school made it sound so hard. When do I use saline and when do I use H2O2 and when do I use the pipe cleaner??? Ahhh!!!"
I've got to say, Brandon's right. Think of it as an opportunity. Expand your repertoire of skills! Everyone that's learned to do something at one point didn't know how to do it. Things are less intimidating if you just look at it as a challenge instead of a "OH NOS! THEY'RE GONNA TAKE MY LICENSE AWAY IF I LOOK AT THE PATIENT WRONG!!" We're nurses. We can rig together any kind of cockamamey thingamajig to make anything work. Is there really a piece of equipment or drug they could put in front of us that we couldn't learn?
We CAN rig, we most certainly CAN learn, we ALWAYS made do. But we shouldn't have to unless we're on a battlefield or at a crash scene. In a "civilized", every day kind of setting, we should have orderly orientation and education procedures, proper and sufficient supplies, mentors, helpers, and all that. We should not be hit by a secretary trying to shock us so we'll quit so her 3rd cousin's neighbor's fiance can have the job we just got hired for. You see? It's one thing to be open to learning. It's another to be just plain victimized.
:eek:
:no:
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 . 
ShimmaShimma0304
124 Posts
@Roser13.... Ummmmm... NO!!!! ;0)
It has been clarified to me that I will be oriented, I do not HAVE TO work in there if I'm not comfy, I will ALWAYS have a back up person, Joint Commision came thru recently and is aware of LPNs working in there as they are experienced and the level of care of these ICU patients is NOT like that of a non-LTAC ICU: real big hospital. I am feeling less stressed. Respiratory therapy at this LTAC is amazing, as are the supervisors and other trained ICU staff, I'm told. So... There ya go. ;0)