Once you go ICU, you never go back..... - page 3

1. 
   Apr 8, '03

   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!
2. 
   Apr 8, '03

   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.
3. 
   Apr 8, '03

   Hmmmm!!!! Tell me more about this Diprivan, remember I work in Psych :chuckle
4. 
   Apr 8, '03

   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
5. 
   Apr 8, '03

   Anne, Welcome to our ranks. I love ICU, and could not imagine working elsewhere. I love the challenge, and there is always something new to learn.
6. 
   Apr 8, '03

   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!!!
7. 
   Apr 8, '03

   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.
8. 
   Apr 12, '03

   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!
9. 
   Apr 12, '03

   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.
10. 
    Apr 12, '03

    Jenny,
    
    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.
11. 
    Apr 12, '03

    We are ALWAYS 1:1.........always.
    
    We are a 23 bed unit with a 4 bed CVR beside us that we staff as well.
    
    I just can not imagine anything more than 1:1..... I guess it depends on your acuity.. but I agree with Jenny that if a pt is in ICU they need INTENSIVE CARE.
    
    Even when people go to to break and we are then covering so it is 1:2, we run the whole time ..... can not imagine being able to do it my whole shift..esp with pts who are on balloon pumps- CRRT- ossilators- etc etc......
12. 
    Apr 12, '03

    glad you like it kc chick, i feel the same about L&D but not ICU, i still like ICU but would never go back to it full time again
13. 
    Apr 12, '03

    Actually sometimes I like to venture out of ICU to keep a fresh perspective. I do some perdiem work at a rehab hospital and a local hospice which has been a nice change of pace. 10 years ago I hated floating out of the unit though.
    
    Whenever Jenny talks about nursing in Minnesota I get homesick.... It's a great place to be a nurse for sure.

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