Interview for Transitional ICU Position

OrganizedChaos, LVN · Sep 7, 2015

I used this site for my dysrhythmia course. It may help with brushing up on rhythms.Free ECG Simulator! - SkillSTAT.

This is great, thanks!!!

OrganizedChaos, LVN · Sep 7, 2015

Our similar unit is called the step-down unit. These included critical drips like cardizem or amiodorone that couldn't be titrated on the medical floors. My patient ratio then was 4:1 (we had no techs...boo.) It was amazing what their absence showed us we took for granted. (finger sticks, toileting) . Shucks.
Our CCU and (icu and sdu) and our ED have critical drip binders that have the drips in it so you can see the starting rate and titration limits. Which is a relief because I can't remember all of them, but knowing I could look it up was reassuring. Plus, I had better ownership over the information and could say with confidence what I did and why.
When I participate in peer interviews I love to ask the question "Tell me how you handle difficult dynamics at work," or "Tell me of a time you demonstrated critical thinking." I like leaving them open ended because I don't want to hear the simple "I'm a team player," or "I have good critical thinking skills." I'm all about SHOW me how you are a team player and why, SHOW me what steps you took in a critical thinking moment.
Search for information on prioritizing critical patients. For me, from the ED perspective it's less about their acuity score (sometimes arbitrarily assigned by the triage nurse before a full assessment is done) but more by their immediate needs. ABCs (DEFGHI) come in handy when you can square away what is necessary. You may not need that full primary survey in the TICU, but those orderly assessment skills are important in any setting.
I find the more systematic the approach, the more second nature it becomes. It takes practice, but a passing familiarity with it can get you started.
My fingers and toes are crossed for you, love.

Thank you! I'm looking up LOTS of interview questions. I'm trying to be prepared as I can be, but I know I'll still be really nervous when the interview comes. I get nervous thinking about it!

OrganizedChaos, LVN · Sep 8, 2015

I want to thank everyone for all their input. The interview went really well & I got along with the NM extremely well. She has more interviews to do this week & hopefully I'll hear by next week. Fingers crossed I get the job! She was really impressed by the questions I asked, again, thanks to all of you! :)

OrganizedChaos, LVN · Sep 9, 2015

I would definitely ask about ratios in the interview. These sorts of units can vary wildly on ratios - I have worked places that took as few as three to places that took five, and five is unacceptable when you are titrating drips. It's just way too much to keep track of.

During the interview she said the nurse to patient ratio is 4-6:1. If I get the job, should I accept or turn it down? If 5 is too many when titrating drips, should I be concerned?

RescueNinjaKy · Sep 9, 2015

My ratios is 4 during day and 5 during night. Ideally they'll try to disperse the drips and so that you won't end up with all of them but hey I've had it happen to me before. 3 of 5 patients with brand new drips all given to me, they weren't on it prior so charge didn't know at assignment. It didn't help that I had a discharge and an admission and a confused patient that night. Luckily, my co workers were more than helpful that night and they all pitched in.

I've heard of getting 6 patients at night if we are really slammed and short staffed, but that hasn't happened to me yet. I personally don't think having 6 patients is acceptable in a progressive care, that just really decreases the quality of nursing care. You should see what resources are available and if they are short staffed regularly. Nothing sucks more than being short staffed, I mean not enough nurses and no enough aides on the same night is a nightmare.

OrganizedChaos, LVN · Sep 9, 2015

My ratios is 4 during day and 5 during night. Ideally they'll try to disperse the drips and so that you won't end up with all of them but hey I've had it happen to me before. 3 of 5 patients with brand new drips all given to me, they weren't on it prior so charge didn't know at assignment. It didn't help that I had a discharge and an admission and a confused patient that night. Luckily, my co workers were more than helpful that night and they all pitched in.
I've heard of getting 6 patients at night if we are really slammed and short staffed, but that hasn't happened to me yet. I personally don't think having 6 patients is acceptable in a progressive care, that just really decreases the quality of nursing care. You should see what resources are available and if they are short staffed regularly. Nothing sucks more than being short staffed, I mean not enough nurses and no enough aides on the same night is a nightmare.

I hope it's rare that I get 6 patients but I know 5 patients is common. I would be working days & evenings. I hope to get the job I just worry about the ratios & because they are short staffed with aides it will be even more difficult. :/

icuRNmaggie, BSN, RN · Sep 9, 2015

The ratio 4 to 5 is doable if these gtts are non titratable such as lasix, amiodarone protocol, or integrelin, Angiomax, post heart cath etc.

I am guessing that your unit has stable stepdown patients and post Cath pts or CABG pts.

That is usually very "cookie cutter" if all goes well.

Pts on insulin gtts for DKA and precedex for dts can be very busy and a 5-6 ratio without a tech is unsafe.

If you like a challenge, take the job. You will learn skills that you can take with you anywhere in life. You should be given 12 weeks of orientation and ideally a critical care course.

SubSippi · Sep 9, 2015

I hope it's rare that I get 6 patients but I know 5 patients is common. I would be working days & evenings. I hope to get the job I just worry about the ratios & because they are short staffed with aides it will be even more difficult. :/

Six would be WAY too much on a cardiac step down, even on nights. If you get offered the job try and see if you can shadow so you can ask nurses questions without the manager staring at them. Taking care of six patients is hard enough, but there is way more charting in an ICU or step down, and you could very easily miss things and end up getting yourself in trouble down the road!

I honestly wouldn't even consider taking a step down job where having six patients was anything more than a freak occurrence.

icuRNmaggie, BSN, RN · Sep 9, 2015

It's hard to say if the ratio is unsafe without knowing the acuity or admission criteria.

Transitional ICU could mean anything. I am picturing an IMC or PCU with stable bipap, controlled afib, temp pacing wires in stable condition, and a whole lot of post ops.

A job shadow is a great suggestion.

OrganizedChaos, LVN · Sep 9, 2015

It's hard to say if the ratio is unsafe without knowing the acuity or admission criteria.
Transitional ICU could mean anything. I am picturing an IMC or PCU with stable bipap, controlled afib, temp pacing wires in stable condition, and a whole lot of post ops.
A job shadow is a great suggestion.

That is exactly what they get. Anything more serious goes to ICU. Any wounds go elsewhere.

OrganizedChaos, LVN · Sep 9, 2015

Thank you everyone for your input. :) I definitely think about everything that was said. I am pray so hard I get the job because it will be a great learning experience for me. Not only will I learn a lot on the unit but I will get the chance to float to other units.

OrganizedChaos, LVN · Sep 9, 2015

That float option is one I enjoyed. Some are wary of it. But we each have our own comfort zone. I loved that it made me more marketable, provided more skills and cross-training, and gave me more options to pick up shifts if needed.
Plus, think of all the application of new knowledge you're gaining! Practical reinforcement of your education is priceless.

I about died & went to heaven when I heard we would get to float. I wanted to end the interview & say, ok you're going to hire me, right? Haha! I love the idea of floating to other units. They don't do wound care on the TICU so if I float to med/surg I would do it there. It would be such an amazing job.