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Discussion

Need to assess this unit

I decided a month or two that I'm not a tele for life kinda gal, and I'd like some critical care work, whether it be ICU or ER, I don't care. So, yesterday AM I got my happy butt out of bed and took my newly tuned up resume to the only hospital that the email failed a send on. (This was because I can't type, I found out later.)

I got a surprise interview, and a job offer pending reference check, which they were doing as I was leaving. What I'd like to do is bounce some of the things I saw and heard off you guys to see what you think of the place since, to me, it sounded good, but I haven't worked in any ICU.

Ok. Small hospital, 50ish beds. Six beds in ICU, 39 med surg, there's an OB department and an ER in there somewhere. It's clean, not cluttered. We went through jcaho recently so yeah, I noticed the hallways. They make good use of LPN's in this hospital, and ICU can be 1 RN and 1 LPN, or two RN's and 1 LPN, depending on census. RN has to do admissions, etc. and at no time may the unit be without an RN, period. House supervisor relieves people for their breaks. ICU is the tele monitor for the med-surg unit.

Charting is all computerized, at bedside. Monitors are (gasp!) where I can reach them. (I'm really short. I notice that stuff. ) Meds are Omnicell, there is no unit secretary. There is no such thing as charge nurse, because with two people really, what is the point? And the facility by definition, specifies that their charge nurses do not take patient loads, so they don't have room for an extra nurse in ICU to not take patients. They do team nursing in there. They had two patients yesterday, three days ago they had 6, census varies widely.

Self scheduling is the thing due to small number of employees, 12 hour shifts, DON likes for people to have days off in a row please. No mandatory overtime, no call. If there are blanks in the schedule people just put down for which ones they can work or want to work. The director also works shifts if needed. Orientation is a combination of OJT and online classes. The director proposes to match my base pay, which is decent for my area, shift diffs are in line with what I've been making so far. Train on days to begin with, move to nights and learn as I go.

So far, I feel I've got the ability to organize, absorb info quickly, decent assessment skills and a good amount of energy in my corner. I'll admit that on the job learning, while it sticks with you, does intimidate me. In fact everything about the ICU intimidates me, that's why I want to try it. The director seems to me to be the kind of person I would enjoy working for: keeps things simple and to the point. They lost people to sideways transfers in the facility, is the reason for the opening. Oh yes, and if their census is really down, we're free to cross train for ER or OB or help out in med surg if they need it.

So tell me what you guys think. I'm very very tempted.

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A couple of questions to ask.

How do you do patient transport for tests and still have 2 nurses on the unit? Does the manager cover? A nurse from another unit?

Also, what is the level of experience of the other nurses you will be working with. Since you are new to ICU, it would be helpful for you "backup" to be experienced.

Is there a core of seasoned nurses who can be a resource, or it the unit a patchwork of temps, floats, travellers and new grads?

  • Author

Since the interview I've been offered the position, and I accepted. Today I did the pre-emp physical, and the paperwork for HR, and took home the bundle of stuff to read. They were doing the background check. Monday I get to have the PPD read, and then I'll be ready to discuss what the start date will be.

I did find out, for transport the house sup has to cover, along with RT if the pt will need to be bagged. They have no agency, and no temps. The newest nurse to ICU other than me has been there over a year. They normally don't hire new grads due to the lack of either a need or a set orientation program for them. Thanks for the questions though; it's good to get input from someone who's been there.

While trying to sound like I've got a level head, I have to admit that I'm really excited!

Congrats on the new job! I hope you enjoy critical care.

Congrats!! I am sure critical care will be very kind to you. I myself am trying to get back into critical care after doing HH for a little while.

Just curious, can LPNs do IV push meds in your state? If not, you are going to be spending a lot of time doing IV pushes for all your patients if you work with an LPN.

Also, if there are 6 patients, the ICU should be staffed with three nurses, not two nurses.

Congratulations

We have some LPN's in my SICU, they cant do pushes but its ok I dont mind, if there Iv certified they can start lines for me and hang fluids at my hospital, they can also piggy back my abx and some other meds, then they do my cath. care for me insert, take care of, and dc my foleys, they can do Ng's in my state so they do hang tube feedings sometimes for us which when I worked in a nursing home the LPN's did tube feedings all the time, they give my baths, take vitals, pass Ice, perform glucose sticks for me, sometimes draw peripheral lab draws so I dont have to call lab and there pretty good at it. They assist me with complex stuff and dressing changes which believe me in sicu we do alot of. They cant do alot but what they can do helps you out alot and I really appreciate mine. Theyll also help me transport pts. but to work in our unit they have to be ACLS certified, and take a class on Ecg's and cardiac monitoring procedures. But what I want to know if LPN's cant do that much in your state and they dont have a charge nurse then they should just make him/her charge nurse since they dont take a pt. load lol, Im charge nurse all the time and I always have a pt. load so thats just funny.

  • Author
Just curious, can LPNs do IV push meds in your state? If not, you are going to be spending a lot of time doing IV pushes for all your patients if you work with an LPN.

Also, if there are 6 patients, the ICU should be staffed with three nurses, not two nurses.

Congratulations

You're right, I'll be doing a lot of IV pushes. And they up the staffing to 3 nurses (what mix of RN to LPN varies but can be 1 RN, 2 LPN's) if there are 6 patients. And then there will be times when I've got no patients and have to watch the tele monitors. So I expect to work my butt off, but I'm not allergic to work. I'll be starting in May. Like I told my current co-workers, the experience is valuable no matter what. The things about this unit that seem to make it a good fit for me, are the things that are a result of it being a small facility.

  • Author
We have some LPN's in my SICU, they cant do pushes but its ok I dont mind, if there Iv certified they can start lines for me and hang fluids at my hospital, they can also piggy back my abx and some other meds, then they do my cath. care for me insert, take care of, and dc my foleys, they can do Ng's in my state so they do hang tube feedings sometimes for us which when I worked in a nursing home the LPN's did tube feedings all the time, they give my baths, take vitals, pass Ice, perform glucose sticks for me, sometimes draw peripheral lab draws so I dont have to call lab and there pretty good at it. They assist me with complex stuff and dressing changes which believe me in sicu we do alot of. They cant do alot but what they can do helps you out alot and I really appreciate mine. Theyll also help me transport pts. but to work in our unit they have to be ACLS certified, and take a class on Ecg's and cardiac monitoring procedures. But what I want to know if LPN's cant do that much in your state and they dont have a charge nurse then they should just make him/her charge nurse since they dont take a pt. load lol, Im charge nurse all the time and I always have a pt. load so thats just funny.

We have one LPN where I work now, and I don't know if she's ACLS or not, but she does everything except hang blood and IV pushes. So her assignments usually don't include a pt. with a central line, and if she needs to give blood an RN will go with her and actually hang it- she does the rest. And yes, people help her with IV pushes, and an RN will sign her admission forms behind her- although I think they are actually supposed to do a bit more than that, like assess the patient. But my current unit is tele, not ICU. I think I'll basically have the same expectation of LPN's in the new unit, because it's the same state. It seems to me they wouldn't employ LPN's if they didn't have similar expectations of a wide scope of practice, yano?

One of my current coworkers has 15 years experience as an LPN prior to going back to school and becoming an RN. In that time period, she was in charge on a med-surg unit, and also worked quite a bit in ICU. This woman is an amazing nurse. Just about any task that I'm not sure about, or haven't done before, she's an expert with it. That comes from experience, and of course the personality to learn and work and improve in practice.

So basically I've had good experiences with LPN's and we shall see what we shall see. I'm sure the ones I'll be working with can teach me a thing or three.

Also where is this facility because if charge nurses dont take a pt. load thats where I want to go to work it would be nice to actually sit down sometimes. LOL:lol2:

Sounds like a great place! Make sure they give you a good orientation.

Congrats and enjoy ICU!!

  • Author

Well thank you :-)

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