floating and new admits to ccu

[vwenzl]

help, I am a student nurse doing my management leadership class and my preceptor a director of CCU/PCU has given me an assignment to find out how other CCU handle direct admits from the OR or if they do, bypassing PACU and also what happens if you have floated an ICU nurse to another unit and how do you get her back or should CCU nurses float at all?

lots of questions hope someone can help.

thanks

viclynn

[joeyzstj, LPN]

OK, I work in CVICU, however the floating policies are pretty similar to CCU in my hospital. We have a list of dates of when people floated. We very rarely float critical care nurses to other units, however it does happen. If a nurse gets floated to our unit, it is normally to take a less critical patient in comparison to our new surgical patients. Normally we will be the first to be pulled and sent back to our own unit if staffing is needed. The CCU where I work has regular staff and then we have an in house agency, which is called Flex or Registry staff which fills in the staffing gaps. Normally we are scheduled light and the in house agency fills in the gaps. Most of the in house agency are made up of nurses who have worked in critical care for years. The only stipulation is that they cant take new hearts, balloon pumps ect. Those are reserved for our regular unit staff who have them on a more reguar basis.

In regard to the direct admits from OR............Most of our doctors prefer that patients are recovered in the units. Our units are Surgical ICU's. We have an ICU, CVICU, and a CCU. All units deal with surgical patients. It seems to run smoother for the docs when patients are sent to the unit. They dont get hammered with pages for small things. They seem to prefer CVICU due to the fact that we have protocols for almost anything and require very little from them in most cases.

[jbp0529]

Work in CVICU also, and we recover our surgical hearts in our unit.

As far as floating, we are pretty busy most days so its not an issue...we rarely float. However, if census happens to be low and we do float, its to either the medical ICU or the step down unit. Once there, however, we arent pulled back. If our home unit gets busy, either a nurse who is on call gets brought in (like what happened to me tonight), or the charge takes a light assignment, allowing someone else to admit, etc.

Ppl who float to us, either from another ICU, or from float pool, or agency, are given a lighter assignment. They do not take fresh hearts, IABPs, CRRT's, VADs. Also, agency nurses are apparently "forbidden" from taking heart, lung, or heart/lung transplant patients...not bc they arent competent enough but bc of some issue in the past regarding one of our transplant surgeons and an agency nurse.

I guess when i say "lighter assignment", its somewhat of a misnomer. Unfortunately, bc of all these silly stipulations posed by my managers and the cardiothoracic MDs, it usually means these nurses who come to us get some of our long term pts: the total care pts, who are needy, messy, full of bugs, who the regular staff are tired of taking care of, or all of the above lol Its not right, its not fair, it sucks for them, but its just the way it is. Myself and a few others have tried to advocate for the nurses who float, but with no success.

And they wonder why no one likes to float to us. Hmm....

[deeDawntee, RN]

Occasionally the ICU's where I work at night will get patients directly from the OR, bypassing PACU. It doesn't happen often, because we don't like it and will put up a fuss. The attitude is that the anesthesiologist is here for a reason to assure stability to transfer to the unit. Often, they will remain intubated and then it is much less of an issue, since they will just remain sedated.

ICU nurses at my hospital only float to other ICU's so I have rarely seen anyone "pulled back" from an assignment, although it is possible that if parties are in agreement it could happen. There are almost always people "on-call", so these kind of arrangements rarely occur. People who are in the float pool, however, that are ICU nurses can be pulled to other units more easily, since this is more 'expected'. This almost always happens in the first 30 minutes of a shift, as the real needs or staffing mistakes show up. Does that make sense? Also, agency nurses, are rearranged in those first 30 minutes of a shift or so occasionally.

Hope this helps!