how do i go about this situation safely?

[wishiwereanurse, BSN, RN]

I cannot believe I am writing this post, but I've been having goosebumps since I went off shift 3 days ago. My situation is this. I was off work for personal leave for a few months, and when i talked to my manager about coming back to work, she said, "Oh you think we're gonna let you work as soon as you come back? No that's unsafe! We need to reorient you" Anyhow, on my first day back on the floor, i get none of the said orientation, and full load of patients. Okay. I got through the day safely with the help of my charge nurse who also had a full load of patients herself. As a background I have worked this floor for a few years now, so most of the stuff we do I remember. But there are also things they've changed that i need to catch up on.

Second day, I go back, they floated me to the ICU. Although I was working with the best nurse they had on the unit, I was really uncomfortable being there the whole time handling 2 patients. They had floated me down on that floor before, the last one being more than 2 years ago, so I was highly anxious during the beginning of shift. Whole-heartedly, I am not comfortable with critical care at all, and as far as interest goes, I am really not interested in working at critical care units. With the other nurse guiding me on, we get through the night safely.

But I know this won't be the last time I am working there as this wee hospital is changing from having separate m/s and icu floors to just one 'acute care' floor, which at anytime I can be given critically ill patients on my own, with none of the experienced nurses working with me. And this type of workplace has become the type of place that assumes that if you have acls then you are fit to work icu, don't care if you have no training on drips and vents.

I do understand that the only way to learn is to handle patients but in these times, the culture of safety is gone. My co-workers told me things are getting grimm, since I was on leave there were so many codes, and one of them, even with no vent experience they made her handle two patients and she had to call the nurse who was off duty to help her manage the vents because the one she was working with had no extensive experience either. They are good nurses and the place we work used to be a good place to work at but things have changed so much from the day I started here, and the nurses are all wanting to leave and I feel heartbroken too but I think it is time I leave too. But while I am looking for another job, how do i get by with this situation safely? I am seriously having heebeegeebeez and want to just run...

[wishiwereanurse, BSN, RN]

and oh sorry for the long post...tried my best to crunch everything but its just been crazy...

[jadelpn, LPN, EMT-B]

You are apparently not the only one who has little experience with vents and other critical care duties. I would suggest asking if your nurse educator can do any skills days to be able to learn. If your RT can give you and your co-workers and inservice about vents.

If you are becoming an "acute care" unit, then there are things that you and others will not know how to do. It would be wise to use the nurse educator to be able to get some education on the unit.

Also, as "crazy" as it may sound, you could have a staff meeting and ask who does what best. If you are the queen of the IV's, you could do a mini skills class on how to do them. A nurse who did the vent, another skills class. See what the approved skills reference is on your unit. Use that and a copy of the policy as a "handout". Maybe the unit goal is to get everyone certified as critical care nurses, due to the overall change in the acuity of the unit.

You would be amazed at some of the newer nurses who have had recent clinical rotations in skilled care, which would have given them some idea on vents, and other clinical skills that perhaps some of the seasoned nurses haven't done in awhile.

Bottom line is that with this change to getting away from a classic ICU, there needs to be an education program in place. If the facility declines, I would have this conversation with your union (and if you do not have a union your DON) as to do this on the fly is not safe.

[nurseprnRN, BSN, RN]

You can also think about joining the local chapter of the American Association of Critical-Care Nurses, not because you want to be an ICU specialist, but because you can pick up some useful information from their educational offerings. Picking up a few of those "... Made Incredibly Easy" books in whatever looks handy to you will help, too. You can ask your staff development people to network with some of their peers in bigger hospitals to come teach a few once-over-lightly classes, and see if your hospital would be so generous (!) as to send you to some at their place so you can have some hands-on (or at least eyes-on) experience.

[xoemmylouox, ASN, RN]

I agree with GrnTea and JadeLPN. If you are going to stay you need to get some experience/education under your belt. See if your hospital will cover some of the cost. Good luck with this change.

[Been there,done that, ASN, RN]

The facility is changing the model of nursing care without providing the proper /required training. You are being thrown to the wolves , along with your patients.

Consult and inform your malpractice carrier. In the meantime, every time you are pulled to an area/assignment that you feel is unsafe, file an unsafe staffing report to CYA.

[brandy1017, ASN, RN]

While I've heard of this model before, the nurses were hand picked and most importantly trained to do ICU before being thrown into it! Usually an ICU preceptorship is a good six months, I'm sorry ACLS just doesn't cut it! I would look for a different job at another hospital. It sounds very unsafe I wouldn't work there! Not everybody can be an ICU nurse and this without proper training is just crazy!

[HouTx, BSN, MSN, EdD]

I have yet to see a Nurse Practice Act that does not include some verbiage about the nurse's responsibility not to accept any assignment for which s/he is not competent. This is also a very clear competency requirement in accreditation standards related to staffing (both JC & CMS).

As an ICU nurse, I have a lot of experience working with semi-terrified float nurses who had to be dragged through those double doors. The best approach is to adopt a team approach, with each person doing what they are qualified to do. Even though you may not be competent to titrate drips or suction an entubated patient, you can do wound care, baths, hang IVs, etc. Under no circumstance should you be given sole responsibility for a critically ill patient. That's just nuts - and incurs an enormous liability risk for the hospital. I'm sure the docs would not be very happy about it either, since they admit a patient to ICU because of the need for specialty care.

Employers can 'ask' anything they want -- but it's my decision to accept or not.

[Anna S, RN]

The facility is changing the model of nursing care without providing the proper /required training. You are being thrown to the wolves , along with your patients.

Consult and inform your malpractice carrier. In the meantime, every time you are pulled to an area/assignment that you feel is unsafe, file an unsafe staffing report to CYA.

I agree. This situation is very dangerous for the poor pts, and your license.

[toomuchbaloney]

I would be getting written up for verbalizing and documenting in written format the dangerous nature of these assignments and my particular lack of training or expertise to safely provide the care. I do not accept dangerous assignments, never have and never will although that attitude has cost me more than one nursing job.

[TriciaJ, RN]

Do you have a union? If so, they would be the ones to provide the unsafe staffing forms. If you can't get your hands on the forms, no matter. Document your concerns on plain paper. Think of everyone you can send a copy to (JCAHO, Medicare, BON, etc). Bring your coworkers on board, but be prepared for some who won't cooperate. (They'll gladly complain in private but leave it for someone else to stick their neck out.)

The hospital is just pushing the envelope on how much money they can save. As soon as someone has a bad outcome, they'll point fingers of blame at the nurse. Then they'll be shocked, shocked that a nurse accepted an assignment for which he/she felt unprepared. You and your coworkers really need to stand together for patient safety. Good luck!