Forced into ICU With No Training

Editorial Team / Admin · Jan 17, 2021

Is this the same units you mention in this thread?

If so, you need to speak up for yourself. However, you also have to understand that as a worldwide community, we are seeing things we've never seen before and there are times that things aren't going to be ideal. As a step-down nurse, you're already going to be more qualified than a med-surg nurse in handling the patient population in ICU.

What are the differences in types of patients in the ICU vs the step-down unit? At my facility, our intermediate care unit is a stepping stone for those patients who no longer need an ICU bed but are not quite ready for med-surg. These patients can still have invasive monitoring lines and be vented, but they wouldn't be fresh post op hearts, on ECMO or continuous dialysis, or more than one vasoactive drip. Our ICUs also have about three times as many beds as the IMCU, so it is not unusual for patients to be sitting in ICU when not truly needing the ICU level of care. When nurses are floated from IMCU to ICU, these are the patients they are assigned.

You don't really give enough information in your post to help us to help you. You don't mention the patient acuity in the ICU patients you were assigned or the patient acuity in your home unit.

JKL33 · Jan 17, 2021

Can't hurt to put out apps and see what happens.

There are those who debate the part about whether you are likely to lose your license. Personally I consider those rebuttals moot and include other forms of possible disadvantage when assessing the risks/cons of a situation.

JKL33 · Jan 17, 2021

1 minute ago, Rose_Queen said:

so it is not unusual for patients to be sitting in ICU when not truly needing the ICU level of care. When nurses are floated from IMCU to ICU, these are the patients they are assigned.

It wouldn't seem like anyone would need to watch Youtube videos for that, then.

Kinda sounds like they didn't care what would be encountered or else maybe the reasonable thing to do would've been to take 30 seconds to explain and provide reassurance.

missnursingstudent19 · Jan 17, 2021

12 minutes ago, Rose_Queen said:

Is this the same units you mention in this thread?

If so, you need to speak up for yourself. However, you also have to understand that as a worldwide community, we are seeing things we've never seen before and there are times that things aren't going to be ideal. As a step-down nurse, you're already going to be more qualified than a med-surg nurse in handling the patient population in ICU.

What are the differences in types of patients in the ICU vs the step-down unit? At my facility, our intermediate care unit is a stepping stone for those patients who no longer need an ICU bed but are not quite ready for med-surg. These patients can still have invasive monitoring lines and be vented, but they wouldn't be fresh post op hearts, on ECMO or continuous dialysis, or more than one vasoactive drip. Our ICUs also have about three times as many beds as the IMCU, so it is not unusual for patients to be sitting in ICU when not truly needing the ICU level of care. When nurses are floated from IMCU to ICU, these are the patients they are assigned.

You don't really give enough information in your post to help us to help you. You don't mention the patient acuity in the ICU patients you were assigned or the patient acuity in your home unit.

On my unit we don’t have ventilator patients, and the most invasive lines we have our CVLs. No arterial lines. Also no insulin drips, no levophed, no sedative drips. There’s just a lot of ICU things that I’ve never dealt with before.

jlpeace2 · Jan 17, 2021

49 minutes ago, missnursingstudent19 said:

I am a stepdown-nurse. The hospital tried to float me to the ICU to take my own assignment of patients with no training whatsoever. When I expressed concerns to my manager, I was told “go home and watch Youtube videos”. I told her I was worried for my license. “Well you put your license at risk working on our floor too.” I was TRAINED for our floor. Time to look for a new job? I don’t think any job is worth losing my license over.

You are supposed to receive an orientation before you are floated to another unit. If you are not receiving an orientation to another floor first it could be dangerous for you and the patient. If anything went wrong it would still be your fault and it doesnt sound like they would be understanding.

You can ask for the additional training but if they did not give it to you I would look for another job but that's me personally. You have to decide if its worth it!

JBMmom, MSN, NP · Jan 17, 2021

Was the scope of the assignment discussed at the time you were told to float? When our disaster planning went into effect in the ICU, part of the management plan was for an ICU nurse to be paired up with 2-3 med/surg nurses as a team. The ICU nurse was going to be responsible for direct patient care and assessments in the COVID rooms, but the med-surg nurses would be handling med-surg appropriate medications and infusions, and would be doing things like titrating pressors and sedation under direct supervision of the RN. Was there any similar arrangement in your hospital? Or were you possibly going to take step-down level of care patients that were boarding in the ICU? That has also happened in our unit in the past. Without more details it's hard to know the exact situation you may have been put in.

Regardless of those details, being told to watch Youtube videos is a completely inappropriate response from the nurse manager and I'm sorry that was even suggested. To state that you're putting your license at risk every day on a unit where you have been appropriately trained is also a ridiculous response. If you continue to receive similar treatment, you might explore other options.

Sour Lemon · Jan 17, 2021

46 minutes ago, missnursingstudent19 said:

On my unit we don’t have ventilator patients, and the most invasive lines we have our CVLs. No arterial lines. Also no insulin drips, no levophed, no sedative drips. There’s just a lot of ICU things that I’ve never dealt with before.

I've been floated "up" (psych to tele) and out of ratio lately, and while I've been concerned, I've been cooperative. Normally, I would not be.

I don't have ACLS and haven't passed a test on rhythms since nursing school, but I feel like I know just enough and have just enough support to handle most of what may come my way.

If I were given titrated drips and vents and other things that I felt were way over my head, I would have to respectfully refuse the assignment (while offering to help in the capacity I was able to). I'd also expect to lose my job, or at least be made very uncomfortable.

This may be a case where there is no "good" choice. Just pick the option you can live with.

JadedCPN, BSN, RN · Jan 19, 2021

The real issue here that would have me looking at other jobs isn't that you were floated to ICU - as others have mentioned we don't know enough details. The assignment could have still been appropriate acuity but there just wasn't bed space to move them to stepdown or acute care, for instance. Also we are living in "unprecedented" times these days where adjustments are being made.

The issue that would have me looking at other jobs is the fact that when you expressed concern, you were told "“go home and watch Youtube videos." That would have me running the other way.

By-a-thred, RN, ADN · Jan 24, 2021

The only job security you will ever have is in your own ability to work within your scope of practice and take care of your own license. And the statement of "go home and watch Youtube videos" smacks of hostile work environment and should not be tolerated.