ICU Nurses

ViolettaCCU, MSN · Apr 27, 2020

Stop creating new protocols from the comfort of your administration desk at home without fully looking into the equipment resources. An example is a new protocol to change out inner cannulas from recovered COVID-19 trached patients. A clear plastic drape is placed over the patient to prevent any air spray from trach stoma. The protocol says to put the vent on "stand-by" to do the quick change. However, not all vents have the "stand-by" mode - it is either ON or OFF. With a vent dependent trached patient - you just can't turn it off and take a few minutes for it to start again. Instead, we try to do the quick change of the inner cannula on the intake of the breath.

Another one is the V60 "helmets" to put over covid positive patients with any aerosol med administration, BPAP/CPAP, or non-rebreather. It's been 3 weeks. We still have not received those so we end up putting a face mask on the patient, over their oxygen apparatus, and stay out of the room for 1 hours post aerosol med administration via ETT.

Having us "crosstrain" nurses from other floors for 1 day. We have reached a plateau and now people are getting called off. However, do not make the ICU nurse the call off in favor of placing other floor nurses in our unit who have never worked in critical care before.

You caught me after a rough weekend. Just my thoughts.

lexotaNIL, BSN · Jun 16, 2020

In CPR they said you can stop it if you are exhausted, I guess that applies to Nurses too...Nurses need good manpower, a proper ratio when it comes to standard staffing..at least be fair enough. there must be an equal proportion to the nurse-patient ratio in the unit. You cannot expect quality care to a 12 patient inside the ICU from a 5 staff only. The failure of some supervisors is as if there is NO CODE at any moment during the shift, so 5 staff is enough to fight the scenario as if they can forsee what's gonna happen in the entire 12 or 8 hr shift. what can you expect from an exhausted nurse and not paid accordingly? well, it's always between the two, either they will stay or leave.

Even heroes have the right to bleed. and it's not easy to be me (nurse)...right?

ViolettaCCU, MSN · Jun 16, 2020

Thank you for your heartfelt comments. I especially identified with "even heroes have the right to bleed".

It has been a couple of weeks (seven!) since I wrote the initial response and, in my area, it the COVID-19 cases are lightening up.

When COVID-19 took over the ICU, the ICU spilled over to the Stepdown Unit. However, those nurses are not critical care trained and, even though they are shown the ropes, they are in no way prepared to care for the intubated, COVID patient. All the rooms have solid doors, one cannot see inside without opening the door (unlike the ICU's that are glass) and they cannot hear when a vent alarm or telemetry alarms sound. The floor's staff of 5 PCTs tend to hang out at the nursing station playing games on their phones! In ICU we have 1 PCT and they are there to help us care for our patient (turning, cleaning, etc). Had a code the other day with one of our ICU COVID vented patients. I can't help but think if it was a critical care nurse caring for this patient, the outcome would have been a lot different. Due to this incident, all vented COVID patients are back in the ICU unit.

Thank you again for sharing!

KeepinitrealCCRN · Jun 17, 2020

Please take everyone else's job off my plate so I can do my own job, that would be great. Thanks.

frozenmedic · Jun 18, 2020

On 6/17/2020 at 12:08 PM, KeepinitrealCCRN said:
Please take everyone else's job off my plate so I can do my own job, that would be great. Thanks.

My day is destroyed by the "death by a thousand cuts" piling on of work.

We want to minimize entry into patient rooms? RNs will now deliver meal trays. COVID tests are getting lost/not resulting fast enough? COVID tests will be hand delivered to the lab. We used to have 2 pharmacy techs come stock our narcotics, now RNs will help count-in narcotics. Plus, the countless hours now spent wiping down used PAPRs. The response from management of course, is always, "but this only takes a minute!"

lexotaNIL, BSN · Jun 18, 2020

On 6/17/2020 at 4:48 AM, ViolettaCCU said:
Thank you for your heartfelt comments. I especially identified with "even heroes have the right to bleed".
It has been a couple of weeks (seven!) since I wrote the initial response and, in my area, it the COVID-19 cases are lightening up.
When COVID-19 took over the ICU, the ICU spilled over to the Stepdown Unit. However, those nurses are not critical care trained and, even though they are shown the ropes, they are in no way prepared to care for the intubated, COVID patient. All the rooms have solid doors, one cannot see inside without opening the door (unlike the ICU's that are glass) and they cannot hear when a vent alarm or telemetry alarms sound. The floor's staff of 5 PCTs tend to hang out at the nursing station playing games on their phones! In ICU we have 1 PCT and they are there to help us care for our patient (turning, cleaning, etc). Had a code the other day with one of our ICU COVID vented patients. I can't help but think if it was a critical care nurse caring for this patient, the outcome would have been a lot different. Due to this incident, all vented COVID patients are back in the ICU unit.
Thank you again for sharing!

I remembered once I said to our nursing directress ''please when you give us new staff at least give us a competent one''. And I understand how you feel...We cannot escape from that kind of problem, as always. You know that thing called ''burned out syndrome?'' it's real. what more this time. I hope you still have the energy to endure all the struggles inside the unit. God bless you.