OMG, I just finished my first weekend of orientation on the unit.....and I loved it! I don't think there's anywhere else in the hospital that I'd want to work after experiencing this. All the staff was helpful, relaxed, friendly and welcomed me with open arms....a very supportive environment. I didn't start the shift with seven patients, which is a big plus.
Even though they were "easy" on me this weekend, I can definately see where it can get hectic even with only 1-3 pts. My preceptor was very grateful that I was there Sat night due to two busy pts out of the three (one was a new vent admit)...the third was a stable. I took the stable one for her and followed her for the other two. I've learned a lot already....vent pts are nice. (Those that have had them know exactly what I mean, don't you?)
HAHA...well, a drug rep for Diprivan told us a story about a pt who after extubation claimed that various erotic acts occured during her intubation. Supposedly, according to the drug rep and then validated by asking other nurses, this is indeed possible. Now, I don't have any sites to back up the erotic dream thing..... LOL.. but the green urine I do if you are interested..
You have 1:1 for a vent! Wow! Last night I had a patient that had just resp arrested and got tubed and was hypotensive and then admitted another with a pons bleed on the vent....doing all the lifenet stuff to keep his organs alive/counsel the family.
I feel our unit is safely staffed.... cannot imagine doing 1:1 for a vent.
We don't oversedate our patients but we do use some in order to control the pain of being intubated and their restlessness... how do you overcome that if they are not sedated? Also, I don't see what sedation and restraints has to do with respect and care... you need to ensure their comfort and safety...
Hmm, never knew about the erotic dream thing. But diprivan DOES turn the urine green.
Wow, Jenny P, any vented pt is 1:1 at your facility? Geez some nights BOTH of my pts are on vents! IABP pt's are supposed to be 1:1 also but if they are stable then they are 1:2.. We are a trauma unit and we sedate our brain injured vented pt's routinely, esp if their ICP is unstable. Interesting how different things are in MN!
Yup... of course is the pt is on CVVHD or is an unstable BP we will make em 1:1. Or if they are very unstable. It is interesting how differently things are done.
Diprivan (propofol) or "milk of amnesia" :chuckle is a sedative/hypnotic that truly is a wonder drug for ICU nurses. Docs generally like it too, because it has an incredibly short half-life. It is fast acting, so if you have a wild patient fighting the vent, you can put them on a gtt and they will literally be out in no time, but will start waking up quickly as you turn it off. It doesn't linger around and you can easily check the patient's baseline neuro status frequently. I'm sure it would be fabulous for those out of control psychotics, but I'm pretty sure your patient has to be intubated and on the vent.:zzzzz
I am also an old med-surg nurse who finally saw the light and joined the ICU. I swear my first night of ortientaion I was taking care of a post op patient that was just as sick as the post ops I took care of on the floor but I only had one not 7. Yes, it is true that the patients can get very sick but you have so much more control!! And i have found the staff to be more helpful. I have never loved nursing more than I have since I found ICU!!!
Propofol is the best drug ever invented!! One of the hospitals that I work in though only uses Ativan. I think it is because of the cost. I can't stand it when my vented patients are awake!! UP the sedation!!!
I too loved the ICU, the constant challenges, always learning new things. Only problem was the 1:3 ratio and the patients were getting sicker and more complex all the time. It simply became overwhelming. A lot of the ICU nurses jumped ship to the PACU. I went to another facility and am now working in a recovery area for heart caths, angioplasties, peripheral and renal stents, etc. The staffing is great.
In my unit we rarely have a 1:3 ratio. CVVHD pt are ALWAYS 1:1. But that night, all three of my pt's were loco!!!!!! Sundowners syndrome totally! The other night I had a post-partum hemmorhage pt! OMG! Don't know nuthin bout birthin no babies, that's for sure. Fundus? What's that? Lochia, anyone? How much is too much? I remembered and quick! That's why I love ICU. You never know what you're gonna get. I've even taken care of a two yr old OD pt before! SO, it's been a little bit of everything. But I prefer the s/p Cardiac surg pt's the best!
For those of you who feel that it's okay for vented patients to be paired; have you read the Standards of Care for Critical Care units that have been put out by ANA and also AACN? BOTH organizations are quite clear that critical care units should be staffed 1:1 or 1:2 for the patients to get the type of care they need.
I feel very strongly that intensive care nursing is just that: very Intensive. And to be able to monitor the patients and prevent nosocomial infections and unwarranted deaths; they should be staffed appropriately. Of course, in my hospital the worst assignements are 1:6-- and that is on med/surg, night shift on a STABLE patient load. And we are unionized with our professional nursing organization- MNA, being the bargaining rep. for us.
We have always done our staffing patterns here on ACUITY not just on ratios. We have been rated as one of the top heart hospitals and ortho hospitals in the nation; and when we have needed to hire traveller nurses; they often decide to settle here and work at our hospital.
This past evening I was charge: we had 11 patients and 9 nurses (counting the charge); one unit secretary and an aide. The aide stocks rooms, helps with turns and transfers, and keeps the physical part of the unit functional. We had 5 patients on vents, of those 2 were fresh surgicals.
We keep it 1:2 unless the patient is crashing. The majority of the time I feel as if this is more than sufficient. We generally try and keep the vents seperated although there are times (such as an all vented unit :) so that it is impossible. I was just surprised to hear that your unit has the staff to keep every vent a 1:1. We are a 14 bed unit and staff 7-8. When we have a crashing patient, we first off all pitch in together... TEAMWORK is an absolute necessity.... but we can also call Clin Administrator and find help either from another unit (six ICU's in the hosp) or bring a tele/stepdown nurse down to help out with the stable, waiting for bed out of the unit type patients.
I agree with you that the ratio should not be higher than 1:2. You are right on there... I just was wondering how a vent was justified as 1:1. :)
(Those that have had them know exactly what I mean, don't you?)
New CCU RN
796 Posts
HAHA...well, a drug rep for Diprivan told us a story about a pt who after extubation claimed that various erotic acts occured during her intubation. Supposedly, according to the drug rep and then validated by asking other nurses, this is indeed possible. Now, I don't have any sites to back up the erotic dream thing..... LOL.. but the green urine I do if you are interested..