Handling multiple ICU patients in the ER

[amzyRN]

I will be finished with orientation soon and am pretty nervous about starting on my own. I've noticed that there are sometimes instances when we will have to manage multiple ICU patients. How do you handle a septic shock patient on 2 different pressors that need titration, a GI bleed getting a central line who will need blood and pressors, and bad COPD exacerbation that needs respiratory treatment now and might need to go on BiPAP, plus you have a demanding psych patient in your other room who's ripping out their IVs?

In a case like this, I would have to ask for help as I don't think I have the ability to do all this on my own. How does a new ER nurse go about being safe and effective? I will ask for help for with anything that I can't handle on my own, but also don't want to come off incompetent.

[Julia77]

If you come in to this mess, you need to let CN know right away. You need to say that it is not a safe assignment before beginning, and I would let my manager know, also.

When you are maxed you need to tell CN right away, and advise that you are 1:1 or 1:2 and need additional help.

If this is brewing, charge needs to know you cannot accept more assignments due to safety concerns.

Agree with above posts on documenting. You have a duty to care for patients you have accepted, but also try to make CN aware before another patient is put into your assignment.

Julia

[Lunah, MSN, RN]

When you are maxed you need to tell CN right away, and advise that you are 1:1 or 1:2 and need additional help.

The OP is in an ER setting, not an ICU. This is the ER forum. :)

[Lunah, MSN, RN]

Just a note — I have updated the thread title to reflect the ER setting. That should help with the confusion of thinking we're talking about the ICU setting!

[Julia77]

I think this may be a case of different locales using different language.

Critical patients are quickly determined to be ICU patients in my ED.

They are then identified as admit-no-bed ICU's. I have been responsible for these heavy, heavy patients in the ED, when in the actual ICU these patients would be with a 1:1 or 1:2 nurse patient ratio. The ICU cannot accept due to inadequate staffing, leading to longer term boarding of ICU patients in the ED. I have walked into an ED assignment with 3/5 patients designated as admit-no-bed-ICU.

Of course, an ED patient may be simply critical and need significant care, but without an ICU designation.

This said, I believe it is key to communicate clearly and assertively with the CN, with the manager, to advocate for patient well-being and safe practice, as mentioned earlier, even if the terminology may be different, or the situation can worsen.

Julia