It's All YOU Baby!

PMFB-RN, RN · Apr 6, 2012

I work in the TMC and I watch my balloon pumps, if we have trouble...circ support, I start my own ivs, I turn my patients, I change my own central line dressings, draw my abgs, etc...I do everything you mentioned except my drips are premixed from the pharmacy so not every facility is the same in the TMC.

*** Our drips are mixed in pharmacy too. However we also have certain ones available on the unit for when we need them STAT. It can take 10-20 min to get a drip up from pharmacy.

Double-Helix, BSN, RN · Apr 6, 2012

Wow! A turn team? A lift team? NG team? I didn't even know these things existed. Where have I been working?

Some are understandable. Most hospitals have a code team. We don't personally call codes in our ICU. We stick our heads out the door and yell "HELP!!" since we have a resident on the floor at all times. The hospitals does have a phlebotomy team for lab draws, but they don't come to the PICU. We do those ourselves.

I have to wonder, though, if the WORLD FAMOUS MEDICAL CENTER doesn't have the right idea. I can't help thinking that nurses in general would feel less overworked and burnt out if there were ancillary staff for those types of things.

Rather the nurse's report going like this:

3 patients.

A's is an admission coming from med-surg s/p abdominal surgery. Looks septic. His BP has been dropping and MD wants a dopamine and epi infusion ready.

B's been vomiting all night and needs you need to place an NGT as well as draw a stat CBC and CMP.

C's been desatting all night and you need to draw ABG's q hour. Also has pressure sores on b/l hips and you need to turn him q 30 minutes. Oh, and he weights 350 lbs.

Plus, it's Friday, so all your IV sites need to be rotated and CL dressings need changing.

Report goes like this:

The admission team will be handling the post op coming from med-surg. They will do the paperwork. He looks septic and BP has been dropping so I've called the pharmacy to make the dopamine and epi drip the MD ordered.

I called the NG team and the lab regarding patient B. He's been vomiting and needs and NG and a CBC, CMP. They should be here soon.

C's been deserting all night. Respiratory has been notified that he needs ABG's q hour. He has b/l pressure sores but the turn team knows to come every half an hour. Don't forget to call the lift team if you need help repositioning, since he's a big guy.

Remember that it's Friday so the IV team will be around to change the IV sites and do the central line dressings.

I know that I would personally be a lot more comfortable managing that patient load knowing that I didn't have three sick patients and an overwhelming list of tasks, but there were actually some people to help out. Of course, this isn't a reality for most nurses, and we are quite used to doing everything on our own. Having teams for all this stuff seems like a dream that many of us know our hospital will never make come true. But I have to say, if I had more time to focus on my assessments and frequently re-evaluate my patients, rather than being so task-oriented, I think the patients would get much better care.

PMFB-RN, RN · Apr 6, 2012

Wow! A turn team? A lift team? NG team? I didn't even know these things existed. Where have I been working?
Some are understandable. Most hospitals have a code team. We don't personally call codes in our ICU. We stick our heads out the door and yell "HELP!!" since we have a resident on the floor at all times. The hospitals does have a phlebotomy team for lab draws, but they don't come to the PICU. We do those ourselves.

*** Our hospital has many of those things too, but not for SICU. We have a very well managed code team but 2 ICU RNs make up 1/3 of the code team. We almost never have any kind of physician in the unit. the come and round in the AM then leave. There is a midlevel who is in the unit until 1500 then nobody. We have a resident covering but he also covers trauma and emergency OR cases so often there is no way possible to get a physician at the bedside. We can call in the attending and do when we need to but they are at home so it might take them up to an hour to arrive.

Short of a major disaster we never have more than 2 patients and one patient is far, far more often the case. I know in 2010 while on light duty I had to collect data on howoften our nurses had two patients each. Well of course some nurses always choose the most stable patients and so have 2 patients more often. On looking through my charts I worked for a whole summer of 2010 never having two patients.

klone, MSN, RN · Apr 6, 2012

I've worked at the small community hospital, and I've worked at the "world famous medical center" and I gotta say, when you have a code, or a question in the middle of the night, it's quite nice being at the "world famous medical center" when you have a room full of residents and an attending and a code team and a IV team and someone from RT there, a whole bunch of people who have got your back.

Having done it both ways, I can't say that I'd want to go back to the small hospital again, especially on nights. No thanks.

Esme12, ASN, BSN, RN · Apr 6, 2012

Recently I have been orienting a new hire to the SICU. The hospital is a large hospital in a small town. This nurses has 3 years ICU experience working at "THE World Famous Medical Center". She has been shocked at how we doing things here in the sticks. She asked me who comes and monitors the balloon pump?
I answered "you of course".
Q: What is the number for the IV team?
A: You are the IV team. (Turns out this RN had never attempted an IV in her life)
Q: Does the turn team come on odd or even hours?
A: You are the turn team for your patients.
Q: Who comes and places NGs?
A: you place NGs on your patients.
Q: Does the admission teamwork at night?
A: Yes! You are the admission team and you work nights.
Q: Where can I find lab's number to come and draw this CBC?
A: You are the lab draw person.
Q: Who changes central line dressings?
A: It's all YOU baby!
Q: We need a STAT levophed gtt, where can I find pharmacy's number?
A: Here is a vial of levophed and a 250ml bag of saline. You get to mix them.
Q: Do I call RT to draw this ABG?
A: Here's your syringe with needle attached.
Q: How do I get ahold of the lift team?
A: You stick you head out the door and ask anyone you see for help.
Q: What resident do we call now that our patient has gone into rapid a-fib?
A: You deal with it per protocol.
Q: What is the number for the code team?
A: You ARE the code team, at least a good chunk of it.
This nurse is obviously very bright and knows her stuff. However it has left me wondering what RN's do at "THE World Famous Medical Center"?

My first response was to laugh, I spit my coffee on all over my laptop....you are 100% correct. :lol2:I've been given that "look" of incredulousness of "Your kidding I do ALL that here?" and I have to supress a chuckle every time. Do I detect New England here? Wicked????? :smokin:

I am NOT fond of some of "The Major Medical Centers". I find after being fiercely independent in ICU that the presence of all these extra people REALLY irritating and I DESPISE waiting for everything and It annoys me to NO END to argue with some over confident resident arrogantly asking me where I got my medical degree to practice medicine when I've been "practicing medicine" before his PARENTS were born.....grrrrrrrrr.

Now that I've had my fun........the nurses are very smart they just aren't used to doing so much for themselves. Many ICU nurses that come from large centers to "slow it down" are often shocked to what actually goes on outside of academia She' msprobaobly wondering what the heck she go into.....show her the ropes! I'm sure she'll do fine!

Double-Helix, BSN, RN · Apr 6, 2012

i can see both sides, especially in an ICU setting. You often don't have time to wait for a team to arrive if you need something emergently. I also enjoy knowing that I am competent enough to perform all of these skills, if I had to.

Plus, I can see what would happen if an NG team (used to adults) came to PICU.

Disgruntled man walks out of patient's room: "I couldn't get an NG tube in your patient."

Me: "What happened?"

NG Team: "He wouldn't hold still and let me put the tube in his nose."

Me: "He's two years old..."

caroladybelle, BSN, RN · Apr 6, 2012

I work at a "world famous" facility in an Oncology ICU.

While we do have a few duties deferred to residents, we do all our own turning, cleaning, blood draws, IVs, baths, often transport, monitors, cardioversion, initiate, do admits, cover codes and run them in areas not ICU, ACLS if MD not there if the pt is that sick, they generally are there), mix stat drips, place foleys, rectal tubes, NG/OG tubes, etc. And do the AM presentation, for the combined team rounds.

I will say that the Onco center works

differently than the main hospital, where they do have IV teams and phlebotomy, but everyone does foleys, lifts etc.

As I have worked at 4 of the top 15 hospitals, I have to wonder which " World Famous" one this is.

BostonTerrierLover, BSN, RN · Apr 6, 2012

I hope my fellow Mississippi Colleagues haven't read this, packed up, and are planning a relocation to Boston, MA!!!!

Going to be a lonely ER Monday, Lol!!!!! We have to do everything, and I mean even some real crude Improv- that I would NEVER tell!!!!!! I wouldn't even ask the BON if it was okay with your Email!!!!!! Lol, that said, it's been a pretty uneventful week here, but last week, if I wouldn't have had duck tape, Heaven or Hell one would have just gained another not-so-sharp-shooter!!

I also have seen EMT/Paramedic's with HUGE knowledge basis's to pull from. One did something in field the week before last that would have made a Neurosurgeon feel proud!!! A doctor signed off on everything of course, and our main state hospital for trauma is 30 minutes by helicopter!!!! That nursing system would be a dream here!!!!! Everyone feels that "Your all alone no matter what" feeling out here. It is too much for some nurses, and I would never recommend a hospital like that to a "New" nurse, or career change nurse with rusty skills, unless they were trully eager, and learned really fast!!!

But, . . .from what you added, sounds like she will be fine!

MomRN0913 · Apr 6, 2012

A lift team? A turn team? They hire people specifically for these things? Wow, why would she ever leave that hospital?

I worked in an ICU where we did everything. The ICU I worked in did all the things above ourselves. Except RT did draw the ABG's.

Really, you can't fault her, this is where she worked out and how things were done. It would probably be a culture shock to you to if you went to the hospital in which she worked.

Crazy though.

Thunda · Apr 6, 2012

I have to say as a Nursing Student I would LOVE to start out in the sort of environment where I'm responsible for all that stuff. I want to be exposed to everything so I feel confident in the most situations possible.

Where do I sign?!

sharpeimom · Apr 6, 2012

i never worked in the world famous medical center, but i did work at a world famous psych hospital in a very large

well known city once upon a time. then i moved and worked in a state psych hospital and it was the difference between night and day.

we may not have had scads of residents and interns, the doctors didn't come regularly but did come when we needed them.

the meds came bulk, in jars of 1000, and there was no unit dose until only a couple of years ago, but the nurses actually made

fewer meds errors.

until just a few years ago when the courts deemed it "exploitation of unpaid patients" and shut the program down, the state

hospital was largely self supporting. they had cows, hens, gardens, and fruit trees.

a world famous psych hospital had only patients who had insurance, a real live former country club chef and sous chef,

a spa and aerobics program that beat the heck out of the yw one i used, most floors offered a choice of group times in case patients

weren't larks/owls. there were private psychiatrists by the bunch, interns, residents, research assistants and directors, lab techs who drew blood without leaving a nasty old bruise.

oh well... you get the idea. guess where i preferred working? it was a definite adjustment doing bulk meds, navigating a campus where

every stupid building looked just like all the others, and there was no ancillary staff, but it was a quick adjustment and i adapted.

some of the older nurses of my mom's generation or above, thought i depended on drugs like haldol, ativan, valium, etc. too much but

my other skills eventally got more finely tuned.

i'll bet that if you are all patient with her, she'll adjust.

PMFB-RN, RN · Apr 6, 2012

I should add that our hospital (580 beds) is actually larger in number of beds than "THE World Famous Medical Center" where she came from, but we are located in a fairly small town. We are also a trauma center. Our SICU is much larger than the CVICU where this particular RN came from. It's not a case of big hospital RN now working in a small hospital. One of the main difference is that at "THE World Famous Medical Center" they have seperate ICUs for each patient population. For example in our SICU we have open heart patients, trauma, general surgery, neuro surgery, oncology surgery, limited burns, and MICU overflow. In addition to our nurses being on the code team for the whole hospital we are also the trauma responders. When the trauma team in activated it is an SICU RN who responds to the trauma bay and acts as the nurse for the trauma. The ER nurse is a helper, does documentation and runs to get things. The SICU RN follows the patient to CT and or OR and then to the SICU and becomes that trauma patients primary RN. We have all the usuall trauma certifications like ATCN or TNCC. In addition the SICU RNs along with an RT are the rapid response "team". We also manage our own vents with the RT just coming by to do vent checks q shift and they are on call as experts when one of us needs help with vent related issues. In the last year it has been decided that we will also be doing our own hemodialysis. The reasoning being that since we ICU RNs already run CRRT and hemodialysis is just fast CRRT they could save a bunch of money by not paying a dialysis RN to come to the and do it. I should mention that I am more comlaining and NOT bragging.

The RN I wrote about in the OP is doing superb and learning very fast. She will fit right in. It helps that even though she came from a different enviroment, she is at the core a very good nurse.