Once you go ICU, you never go back..... - page 4
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... Read More
Apr 12, '03Originally posted by JMP
We are ALWAYS 1:1.........always.
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.
...... 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......
JMP, I feel the same way you do: with the acuity we have, and the fact that we do not routinely sedate our vented patients (we do sedate those that are trying to self-extubate, etc., but only for the briefest time necessary), plus a few other facts (we are not a teaching hospital; no residents or docs routinely on the unit), we are able to prevent crisises before they happen by excellent nursing care alone.
We are a 22 bed CV-ICU unit, 70- to 80% of our vented post-op CABG patients are extubated within 5 hours after surgery (plus we are getting more and more pts. that have been extubated in O.R. after their heart surgeries). Nearly 70% of our post-op CABG patients are "fast-tracked" out of the unit by 10AM the morning after surgery, and these patients have been weaned down to nasal cannula O2, all drips weaned off, lines removed, bathed, dangled at least x3, and up in chair at least x2, PLUS up in chair for breakfast; IS q1-2hr while awake, all AM labs and CXRs done, etc. All of this is done by the RN at the bedside. A nurse with 2 "fast-trackers" is literally running all night to get all of this and the (computerized) paperwork done! Many of these patients may be inour unit less than 18 hours, and we still are able to do this due to our staffing.
Our nosocomial infection rate is extremely low, and I don't remember the last time we have had an outbreak of MRSA, VRE, or C.Diff on our unit: it is always confined to the pt. who came in with it.
I know; I'm bragging, but we are good at what we do and I believe that nurses should be proud of what a good job we do. The nurses have been the ones who designed the unit, the nurses are the ones who developed our pain management plans, the nurses are the ones who implemented the "fast track" program, and so on. Is it any wonder that over 30 (out of 80) of the nurses last year were recognised for being on this unit for 10 or moore years?
Apr 12, '03I did ICU for 3 years, then went to CT ICU for 14 years. Most of the time intubated pt's were 1:1 ratio in the CT unit.
I loved ICU nursing, and CCU, but after so long of a time, it kind of got to me. All ICU nurses know what I mean, esp when it comes to ethics. There are a lot of ethical dilemmas in the ICU when dealing w life and death so intensely. I kind of got burned out.
I went from there to a PACU, which I frankly think is THE sweetest deal in nursing, my friends there said PACU is where old ICU nurses go to die, and I loved that statement. I just hated the call in that particular unit.
Then I tried Home health for something different, and I strongly feel that ICU nurses make excellent case managers and great HH nurses. You still get a 1:1 ratio per visit, so you still get to give the wonderful attention that you did in ICU
I am glad you love it KC. You will learn so much, and there are so many rewards, like nimbex's story. Thanks for sharing that nimbex!!
Apr 12, '03I have done all types of critical care for the last 35 years. Went directly into surigcal open heart at graduation 35 years ago. For the last 12 years have worked 2 days Cardiac Rehab and 3 days CCU. Just quit CCU and am now working full time Cardiac Rehab. Very little stress, if you see inpatients it is always a 1:1 visit. Outpatient can be large groups but they are out of the hospital, generally 2-3 months out from their event also. At any sign of trouble we call the EMTs to ship them to the ER.
Apr 13, '03I loved ICU, I hated ICU...
I loved the lower patient ratios, having more time to interact with and educate patients and families. I wouldn't say I enjoyed the end of life/withdrawal of support/organ donation part of it, but I enjoyed being good at it. I loved the detailed knowledge and care I got to give. I loved knowing what drip or vent setting to tweak to get things straightened out. I loved working in places where docs respected an experienced ICU RN's input in diagnosis and treatment- being a team was great.
I hated the physical toll of it. No CNA- we did all our own lifting and turning and trips to cat scan. I hated working in poorly staffed or poorly managed ICU's. I hated working in places where a sick patient on a vent wasn't seen by a doc (any doc) for 2 days. I hated having THAT much responsibility with so little authority.
So after doing some time in SICU, CVICU, and Trauma ICU, I made the move into Interventional Radiology. And I love it. I get to manage procedural pain and sedation. I get to be the calming force in the unit ("No, he's not coding, it's OK") because the docs and rad techs, while great at their jobs, don't manage clinical crises. And I don't miss the visitors or oppressive families! ICUs are becoming more open (sometimes TOO open) but no one even tries to visit during the angioplasty. <g> And I don't float anywhere.
Of course, there are some things I miss about ICU. <g> I miss seeing how things turned out- I only have the patient for a couple hours. I miss providing hands on care. So I pick up extra hours in PACU and SICU when I feel like it. When I don't want the stress, I happily stay at home in IR.
To touch on another subject, what I was used to for ICU ratios was 1:2 except for open heart <4 hours postop, or CVVH. IABPs were supposed to be 1:1's but could be made a 1:2 if stable and the other patient was sedated and stable. Not ideal but...
Never heard of 1:1 for all vents. Wow.
Apr 14, '03I agree ICU is wonderful, I have been a NICU for almost 2 years and love it!! I love working with the preemies! I worked on a med-surg unit as a student and absolutely hated it. I definately know I am a baby nurse not adult one!!
Apr 14, '03I'd just like to weigh in on the propofol fanfest. Yes it's a wonder drug... but it can cause lethal dysrhythmias in the pediatric patient if given for more than a few hours. We generally only use it for fresh post-ops who are likely to be extubated within a couple of hours of admission. In the last unit I worked in, we had a teenager, sixteen years old and six feet tall who came in with an intracranial bleed of unknown etiology. For some reason, it was decided that because of his age, it would be okay to run propofol on him continuously for days, in ever-increasing doses. He began having ECG changes on about day five, and on day seven developed what appeared to be V-tach on the monitor. It was treated as such but that wasn't what it was (can't remember at the moment exactly what it was... oldtimer's moment here!) and he died. Very sad.
Apr 14, '03In my hospital, we don't have Pediatric ICU. SO, pretty much ANY Ped's pt gets shipped to a larger facility
Apr 14, '03Gotta agree with those who LUV the sedated, vented patient! They are my very favorite type of patients!
I've seen a few patients go really bad after being on Diprivan for too long. In my opinion, if a vent patient needs to be sedated for more than a few days, something else should be used (Ativan, Haldol, Valium, etc).
One of the good things about Diprivan is how quickly it works and wears off, but it has some bad side effects too if used for too long. In a person with a lot of adipose tissue, it builds up and takes a long time to clear from the body.
Y'all are right about ICU...it's the best place to work!!
Apr 14, '03'So much responsibility and so little authority.'
Great description of a nurses' job particularly an ICU nurse, Ratchit.
I will also keep PACU in mind Hoolihan...as I is gettin' on in years most definitely...hehe!:roll
Apr 15, '03I would agree with you! Diprivan is a God-send! Especially in the confused, combative patient! If the patient is calm and on a vent I will take that too! Give me the 80 year old, on the vent, with Epi, Levo, and Primacor gtts, anyday! Beats the heck out of......call lights and bathroom duty!
Apr 16, '03From everybody's stories, I can tell that I'm going to love CCU! I can't wait until I start my new job!
Apr 17, '03I just can't imagine vents as 1:1. We are always 1:2 unless it's a fresh heart, cvvhd, iabp. I love working in ICU! I enjoy the increased responsibility -- we really play a part in a patient living or dying. I leave work knowing that I actually helped someone
And yes, diprivan is wonderful for the patients (and the nurses) who are just plain wild while intubated