Just curious; Would this pt be one-on-one in your ICU?

grouchy · May 2, 2002

Thanks for all the responses. It was fascinating-and scary- to see the differences in staffing between different ICU's, and especially between the U.S. and Canada.

My gut feeling is that I could have handled having this pt along with one of the at least 2 relatively stable long-term pts that we had. I couldn't understand why the charge nurse (who did not have an assignment and who did not help me ) was so insistent on giving me a post-op admit. Especially because our ICU pts do not go through the PACU, we are their PACU, including Q15min VS and Neuros. My admit came to me intubated and was extubated an hour later.

Thank God I did get alot of help from the other staff, including a wonderful agency nurse! (I'm mentioning this because I know people often dis agency nurses). And I'm not a new grad, just new to the ICU. Because I'm new to this environment I wasn't sure how much to trust my intuition about this assignment. Now I think my intuition was right!

JMP, I think I want to move to Vancouver!

mattsmom81 · May 2, 2002

Grouchy, it burned me to hear your charge nurse didn't have an assignment and did not help you. I would never do that to another nurse personally. As charge I would frequently offer to take the third patient...I often chose the most stable so I could be a floating resource to the team, do bed control, help with orders, be a gofer, etc.. Only in a highly unusual situation would I be free...like if I had an entire staff of agency, then I might be assigned to be free floating. I worked with a good group...I miss 'em...although I don't miss the politics and administration! LOL!

Sounds like your charge nurse is a bit of a 'challenge' for the rest of you....sorry you have to put up with that.

Funny you mentioned the helpful agency staff...as I found myself often supporting new staff members too when I did an agency shift...some staff abandon them for some reason. Unacceptable.

fedupnurse · May 2, 2002

The vast majority of the Agency staff I work with are former employees who left staff positions because they wanted part time and the suits said no. So they quit and went to work for the Agency "owned" by the hospital and most are making 15 bucks more an hour (most were new nurses). All but one, who was recently canned, have my utmost respect. I'd work with them anytime!

Our managers are unfortunately a waste of good money. They sit in the office while we are drowning and don't help. All of the staff hate to be in charge but we all like it better when it is one of us in charge because we know we won't be left flapping in the wind.

Good thing I love what I do!!!!

FUN

Trauma Columnist · May 2, 2002

What's the ER like in Canada? You guys are so very lucky. Used to be an ICU nurse, before coming to ER 6 yrs ago. Last night we had cardiac peds pt, very unstable, heroin OD dropped on the driveway (CPR started on driveway) and five traumas - all with four nurses!!!!

Charles S. Smith, RN, MS · May 2, 2002

Nope..not 1:1 unless very unstable..could even be a triple with 2 transfers or step down patients waiting for a bed... But...given your experience level, I question what resource you had to back you up, supervise you with unfamiliar skills, etc. Assignment may have been unreasonable for you and your comfort level which should be a component of the patient population assessment in your unit when your assignment was made.

best

chas

Jenny P · May 2, 2002

That patient would have been 1:1 in my unit; our max assignment is 1:2. Everyone is saying "if stable"; I question how stable the pt. is when you are talking about sepsis, q2-4hr labs (including the glucs.) and even the Versed gtt.--- in other words; what is in the "etc, etc." she said AFTER the Versed gtt????

IMHO, if you are doing labs and procedures q2-4hr, you must also be ADJUSTING whatever you are doing to that pt. according to those results; otherwise you are WASTING valuable time, energy and hospital resources by doing all of that stuff that often!

We have our nursing association as our union and are very vocal about pt. safety in my hospital. Filling out a protest of assignment form usually gets results and staff fast for us.

We've had travellers here this past year (unfortunately, they are all gone now!) and when 1 of our pt.s went into V. tach, the traveller ran to get the code cart (which was just about 15 ft. from the bedside) but we had the pt. defibbed and back in SR right away before she'd even moved the cart. The traveller said that "you guys just don't use the code cart as often as the other places I've been"; and when I asked her why; she said "you don't have as many codes!". On asking her why she thought this was true; she said "YOU HAVE MUCH BETTER STAFFING!" Amazing, isn't it?

I'm a very firm believer in fixing problems before they start; how can you be watching for the beginning signs of problems when staffing is so bad? You know, the old saying "if it's lethal, it will come back?" If it's lethal, FIX IT BEFORE it comes back!

Now you KNOW why I've been in my unit for 22 years! Out of about 80 of us, 33 have been there longer than 10 years!

-jt · May 3, 2002

I doubt luck had anything to do with it. Nobody handed them anything. Those RNs stand united together and fought for everything they have. They recently fought the government & practically shut down healthcare in one of their provinces to get their pt safety/recruitment/retention issues addressed. Can you honestly see nurses in any one of our states being so committed to each other and doing that?? The difference between there & here is that they are not afraid to be a strong union, but here nurses say they "dont believe in the 'u' word."

United you stand, divided you beg. Luck never enters the picture.

jefccu · May 3, 2002

The few places that I have worked would have left that as a 2:1 with the second pt. an extremely low acuity pt. Never would be given first admit though.

semstr · May 3, 2002

This patient would most likely be a 1:1^, depends on the other patients though and whether his vitals etc. are stabil.

A RN with

Take care, Renee

PS: same goes for PACU, OR etc.

nilepoc · May 3, 2002

not a one to one here, just tonight we had a

post op whipple that received 6 units of blood, maxed out the dopa, 12 liters of crystal, and 6 FFP, over four hours. Emergently intubated, and rushed back to OR for a crit of 15. this patient stayed paired with another patient who is vented and required constant monitoring. this is why we have a charge without an assignment.

JMP · May 3, 2002

jt

why are so many American RN's against unionized enviroments? I know that in the southern states it is almost a crime to even mention it?

There must be a history behind it? But, I do not know what it is.

Your are right however jt, our union is strong and we are united and support each other and NEVER would some of things I have been reading on this thread happen here.

We have job security, decent wages, good benefits and we also have fairly high union dues. We are well respected and have safe assignments, esp in critical care settings. The other part is that your ability to pay for your healthcare does NOT enter into the picture. Our union dues are about 50 dollars a month. Is it worth it? Yes.

fedupnurse · May 3, 2002

JMP,

Is unionization mandatory in Canada? Is every hospital unionized and if so is it the same union? I work in a unionized facility and while I think it is absolutely necessary, our suits laugh at our short staffing forms. We have no staffing language in our contract. American unions do not stand together as you do in Canada. Please share the secret of your success. Nurses in the USA could take over healthcare if we would just stick together!

Thanks,

fedupnurse