CVVH and the 1:1 assignment

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I have a question. In your hospitals, if a patient is on CVVH, are they automatically a 1:1 assignment? Or is the nurse expected to carry more than one patient regardless of the hemodynamic status?

Any nurses who work with CVVH please respond as this is an issue at my hospital, so i'm conducting a sort of survey just for my benefit.

Thanks

Specializes in Critical Care Baby!!!!!.

hold on to your hats everyone...............the hospital that i worked at for 6 years always paired their cvvh patients, usually with someone waiting to go to tele. this was in a very high acquity open heart unit in the chicagoland area. it became the norm very fast. they also pair their vad patients 2 days post op! :uhoh21:

it is very scary! the last day i worked there my assignment was this..........an open heart patient first day post-op still vented on an iabp with dopa, epi, levo, and primacor, my next patient was 3 days post-op, extubated, still had iabp and dopa, and my third patient was someone waiting to go to tele who developed hypotension on me! scary scary scary!!!!!!!! i left there with my nursing liscence in tact.

it was sad leaving though, because the nurses i worked with were wonderful and we all got along great! the surgeons were awesome too. we were one big family. the management and administration sucked, i guess good manangement can make or break you. they have an extremely high turn over rate. wonder why?:uhoh3:

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I have heard of a very few hospitals doing this in extreme crisis situations (disaster, fire, flood etc...) but I have never heard of it as the "norm". I suspect that this hospitals pt population was either terribly poor, or the pts were unaware of the real danger they were in. Perhaps, this is another example of a hopsital in desperate need of a nurses union. I would definatley contact the INA if your still in the Chicago area. They would be more than happy to talk to you or your colleages. Finally, should a hospital that is unwilling or incapable of properly caring for critically ill patients be ALLOWED to admit and keep them? Should they be forced by the federal government to transfer them to better staffed or equiped facilities?

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Specializes in Critical Care Baby!!!!!.
i have heard of a very few hospitals doing this in extreme crisis situations (disaster, fire, flood etc...) but i have never heard of it as the "norm". i suspect that this hospitals pt population was either terribly poor, or the pts were unaware of the real danger they were in. perhaps, this is another example of a hopsital in desperate need of a nurses union. i would definatley contact the ina if your still in the chicago area. they would be more than happy to talk to you or your colleages. finally, should a hospital that is unwilling or incapable of properly caring for critically ill patients be allowed to admit and keep them? should they be forced by the federal government to transfer them to better staffed or equiped facilities?

the patient population was neither poor or uninformed. they came from all over the country to have surgery by these surgeons. i agree that it is highly unsafe, and if that isn't enough....this hospital just achieved magnet status. can you believe it! :eek: i think something needs to be done, but no one is fed up enough, and when they do get frustrated they leave. also, just so you know, this open heart unit, has extremely low morbidity/mortality rates. the patient population consists of people who were turned away from other hospitals. i have seen miracles in this unit, but there has also been heartache. i think that goes without saying. the patients are well informed of the risks and chance of death. they are also informed of the intensity of the environment. they are urged to tour the unit before consenting for the surgery. it helps tremendously.

like i said before though, these nurses/docs were fantastic, and this place made me the nurse i am today. it gave me the experience and knowledge to work as a clinician for a while, and allowed me to become a good preceptor. the management/administration needs to change, and they need to be allowed to have a larger budget so they can hire more nurses, more fte's.

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1:1 only, unless they wish to give you an extra nurse. But in no way should you have a second patient.

Suzanne, you've participated in my previous thread about this subject back when I had minimal training (Baptism by fire style) and was taking CVVHD patients.

Of course I've gotten more knowledgeable and comfortable with it since then but my hospital still says 2 patients regardless of CVVHD.

A dialysis nurse comes to the floor and sets it up for us initially and then we manage it from there. Is that why we are still taking two patients?

Are other ICU's managed the same way or are many of you setting it up initially on your own as well?

Even managing it after initial set up can still be time consuming with keeping up with the bags, emptying, balance alarms, etc.

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It sounds as though you are very proud of the work you did at this hospital and rightly so. However, I am not going to gloss over the clear facts that you participated in profoundly risky pt assignments. While your level of care was clearly expert, even the experts can only be in one place at one time. This particular tact does nothing to improve patient safety or improve the nurses working environment. I too have worked with nurses and surgeons who were profoundly gifted, however I did not and will never take a patient assignment that place not only my license in jeapordy but pt safety and well being. If your hospital is unwilling or incapable of staffing for CVVHD, VAD's or IABP's or they are placing bandaids on these issues then they should stop accepting these patient and stop holding themselves out to be patient centered organizations. They should admit there shortcomings and just live with it. Nurses are the people who drive this commitment, not suits.

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It sounds as though you are very proud of the work you did at this hospital and rightly so. However, I am not going to gloss over the clear facts that you participated in profoundly risky pt assignments. While your level of care was clearly expert, even the experts can only be in one place at one time. This particular tact does nothing to improve patient safety or improve the nurses working environment. I too have worked with nurses and surgeons who were profoundly gifted, however I did not and will never take a patient assignment that place not only my license in jeapordy but pt safety and well being. If your hospital is unwilling or incapable of staffing for CVVHD, VAD's or IABP's or they are placing bandaids on these issues then they should stop accepting these patient and stop holding themselves out to be patient centered organizations. They should admit there shortcomings and just live with it. Nurses are the people who drive this commitment, not suits.

Which post were you referring to?

I hope it wasn't mine because I certainly am not proud that I caved in and took on CVVHD assignments that I felt I wasn't able to manage independently at that time.

I caved in to my peers acting like I was being a baby about it and should have trusted my instincts that told me that I shouldn't be taking those assignments without more training.

I will say this....it's very easy for us (including myself) on this board to second guess what we as nurses or the hospital should or shouldn't have done when we're not there at the time it's going on.

I admit that I'm not proud of my choice of handling in that particular situation which is why I started a thread asking for help here as my peers acted like I was blowing it out of proportion, but I know that I'm far from being the first or last nurse who took on inappropriate patient assignments out of peer or management pressure so I wouldn't be so quick to act so high brow about it.

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See above, SurghrtRN post. Not taking anything away from anyone. Not about acting "high brow" it is about protecting our profession, or nurse peers and out patients. If you are regretful, as I sometimes am, about assignments, job duties etc, learn from those experiences and try to grow.

Vigilence, mostly an intrinsic trait, can be cultivated in people. It is my belief that a sense of vigilance in ones decision making regardless peer or managment pressure builds confidence. I have actually been told that "we don't have the luxury of 1 to 1 patients". Really? then STOP admitting them, or, better yet, force the managers to decide who lives and who dies. Sounds dramatic, but that is reality in critical care. One to one patients are there, we half to protect them. Be vigilent, be thoguhtful and be confident you are the patients nurse.

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Generally its the nurse incharged and the Nurse whos gonna look after this patient should decide based on the dependency of the patient and how critical will the situation will be on cases of complication with regards to the procedure being done. Here in uk its 1:1 ratio since youre doing a procedure that possible complication is high and paramount is the welfare of the patient and safety of health care workers..

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Specializes in Critical Care Baby!!!!!.
it sounds as though you are very proud of the work you did at this hospital and rightly so. however, i am not going to gloss over the clear facts that you participated in profoundly risky pt assignments. while your level of care was clearly expert, even the experts can only be in one place at one time. this particular tact does nothing to improve patient safety or improve the nurses working environment. i too have worked with nurses and surgeons who were profoundly gifted, however i did not and will never take a patient assignment that place not only my license in jeapordy but pt safety and well being. if your hospital is unwilling or incapable of staffing for cvvhd, vad's or iabp's or they are placing bandaids on these issues then they should stop accepting these patient and stop holding themselves out to be patient centered organizations. they should admit there shortcomings and just live with it. nurses are the people who drive this commitment, not suits.

yet again i must say that i agree that this was unsafe.....hence i no longer work there. yet, this hospital rakes in billions of dollars and as i mentioned before, acheived magnet status, which in my opinion is laughable. it is very easy to sit here and say that you would not accept an assignment ever, but when it comes down to it you do do what you have to do. what i mean is, when they dish out my assignments do i say "no, i will not take these patients." and risk my job, my place in the unit. i need to work! i have 3 kids and bills to pay.....it is amazing what you will withstand for a paycheck.

i could no longer take it, and i made a very hard decision to leave, and i am glad that i did. i agree with what you say, but the truth of the matter is, there are not enough nurses willing to stand up and say "enough! we control our profession and or jobs, not administration or suits!" when i was at this hospital, we had tried to go to hr about these issues and 3 nurses ended up getting pushed out the door. that sent a strong message to the staff to keep their mouths shut. that was the turning point for me, and i started looking for a job after that happened. this is just part of nursing, good or bad, and until it changes for good we are trapped. (let the flames begin!)

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Specializes in Critical Care Baby!!!!!.
Which post were you referring to?

I hope it wasn't mine because I certainly am not proud that I caved in and took on CVVHD assignments that I felt I wasn't able to manage independently at that time.

I caved in to my peers acting like I was being a baby about it and should have trusted my instincts that told me that I shouldn't be taking those assignments without more training.

I will say this....it's very easy for us (including myself) on this board to second guess what we as nurses or the hospital should or shouldn't have done when we're not there at the time it's going on.

I admit that I'm not proud of my choice of handling in that particular situation which is why I started a thread asking for help here as my peers acted like I was blowing it out of proportion, but I know that I'm far from being the first or last nurse who took on inappropriate patient assignments out of peer or management pressure so I wouldn't be so quick to act so high brow about it.

:yelclap: :yeahthat: I could not have said it better myself! :)

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Generally its the nurse incharged and the Nurse whos gonna look after this patient should decide based on the dependency of the patient and how critical will the situation will be on cases of complication with regards to the procedure being done. Here in uk its 1:1 ratio since youre doing a procedure that possible complication is high and paramount is the welfare of the patient and safety of health care workers..

I have met a few nurses from the uk over the years, they tell me great things about the level of practice and staffing in uk hosp's. Much cuddo's to you and your peers.

P.S. We in America stand by our bretheren in the UK during these trying times. We know the spirit of the english people and believe they will NOT cave into terrorism. We grieve with you and for you. RobC

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I have met a few nurses from the uk over the years, they tell me great things about the level of practice and staffing in uk hosp's. Much cuddo's to you and your peers.

P.S. We in America stand by our bretheren in the UK during these trying times. We know the spirit of the english people and believe they will NOT cave into terrorism. We grieve with you and for you. RobC[/QUO

:cheers: http://www.historyworld.net/wrldhis/PlainTextHistories.asp?historyid=aa80

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