New MICN

Medic09, BSN, RN, EMT-P · Mar 13, 2009

with the micn certification i believe you're also qualified to do critical care patient transports with private ambulance companies.....that and the fact that you're giving guidance and orders to paramedics who are en route to whatever facility is why it's considered "mobile". where i work the micn still does patient care when able. we are in charge of the flow of the entire ed, so if we're trying to help someone we often get pulled away to get pt's discharged or to their rooms if we have a long wait in the lobby.

A whole new concept to me, excepting the transport part. Where do you do this?

ERjodiRN · Mar 13, 2009

A whole new concept to me, excepting the transport part. Where do you do this?

i work at a hospital in orange county. the county has what is called "base hospitals". there are about 6 in this county and we each have designated districts that we cover...so any medic units falling in those districts contact us for guidance, hospital designation (trauma, cardiac, or neuro receiving, etc), and orders for additional meds or procedures....or sometimes they just contact because the patients has certain vital signs that meet the criteria for base contact. the calls last anywhere from 2-30+min. we have to take a class to learn the county guidelines and med dosages, etc.....what the medics can and cannot do in the field without making contact, and then we take the test for the licensure. at my hospital the micn also runs the flow board so it's added responsibility. another hospital i work at in the county has the micn take a 1pt. assignment, but it's the last bed that they utilize. it's an interesting position because it gives you a better look at what is going on in the county and what the medics constraints are. the downside is that some of my fellow staff members get tired of the micn's going around and asking them what the delay is in getting their patients discharged or upstairs. it's not that we think they're slow....it's that we need a bed for the incoming runs and patients in the lobby. basically we run around all night getting people out or up, bringing pt's back, moving people here and there (musical beds), while answering all the phones for medic/emt runs and the radio, which for us averages about 20 calls daily. hope this helps!

Medic09, BSN, RN, EMT-P · Mar 13, 2009

Jodi, do you have a Charge Nurse for the shift, as well as the MICN? All the flow-management you described sounds like tasks that a Charge would do.

Medics out here are quite autonomous. In the ED, any nurse can answer a radio call. Most of the time, the medics are notifying, not asking for further instructions. As need be, we get the Charge for a problem, or grab a doc if the medics want further instructions. If the incoming is simple, we may just decide where to put them and notify the Charge (we're a 36 bed ER). Most times we'll notify the Charge and let him/her decide where they want the patient. If it is MI or Trauma STAT (called by medics or us) then we notify the Charge and the secretary gets the appropriate wheels moving.

Does MICN training include ride time in the ambulances? As a medic, I would prefer to take suggestions or orders from a doc or at least a colleague who knows my work well.

ErnewbieRN, we kinda hijacked your thread. Congratulations! Enjoy your new position and may you be blessed with much success with your new responsibilities! :yeah:

ERnewbieRN, BSN, RN · Mar 13, 2009

I agree with what Jodi said, for the most part.. it's just a little different for me since I'm in a more "rural" area (which really isn't that rural but compared to the rest of Los Angeles county, we are pretty much the most rural part)... we don't have as many runs come in so the MICNs are also responsible for a full patient assignment (4 pts) in addition to answering the radio. Basically we determine patient destination, additional treatments, and can call for additional med control (IE pronouncing death in the field).

Medic, we only are required to do one 8 hour ride-along to become certified, but we have to have a certain number of ride-alongs to recert each year. I'd love to do more! We have very strict guidelines as to what kinds of treatments we can order... it is a very regimented system, especially here in LA county where there are so many rules and restrictions for the medics.

Thanks to everyone for the well wishes!

ERjodiRN · Mar 13, 2009

Jodi, do you have a Charge Nurse for the shift, as well as the MICN? All the flow-management you described sounds like tasks that a Charge would do.

medic,

we do have a charge nurse on duty as well. she helps with the patient flow as well, but on a different level. they are usually telling us when we need to close certain areas down (if possible) to free up that nurse because they are eiher a)going home at that time and we have no one to take their spot, or b) they are needed to take the spot of another nurse who is going home at that time.

the charge nurse also goes to a meeting each shift that all the charges in the hospital go to. they find out how many beds are available on each floor, etc. the charge nurse gets a lot of MD phone calls who are calling in patients who have not yet arrived....or calls from snf's for the same reason. they do chart audits on EVERY SINGLE CHART, have to do the pt. census....basically a lot of paper pushing. they of course have to do their rounds in the main er and our 20 bed fast track area on the other side of the hospital. they will also help out when asked by other nurses, and oversee the beginning treatments of the critical patients that come in to make sure things are being taken care of. this frees up the MICN to continue to work the flow board, move patients, and answer any and all calls.

we get the bls and als no contact calls where we aren't giving any orders or hosp designation. the big radio calls are just for more acute patients. the medics are allowed to give meds before making contact, but only certain ones, and only a certain amount of times before contact is required. we are required to have 16hrs of ride-a-long time before we get certified, and then 16hrs every 2 yrs for recert. we're also required to go to the county ems update meetings and RPAC meetings to get updates on what the different medic units are doing/piloting, etc...and any new changes in the county protocols. i loved doing my ride-a-longs because it really did give me a better idea on what it's like being out in the field and the conditions they might be under. it really caters to and builds a greater team effort, which i really enjoy. the only time that we really have to tell them which facility to go to is if we feel the patient fits a higher level of care acuity and shouldn't go to the nearest receiving like they were hoping. our reddinet system also tells us which hospitals are open to certain things like neuro, trauma, cardiac...or if their CT is down, are on diversion for whatever reason, etc. the medics don't always know that off hand and may need to be redirected because of that. really the only time i've ever really given orders for a lot of meds was in a really messy arrest they called for. the rhythm was all over the place so we were pushing everything. other than that it's just extra or double nitros, albuterol, sometimes adenosine (they can't give it without contact unless the pt. has previous hx of svt). they have really limited our medics....which is both good and bad. some medics need the limitations because they aren't.....the best. but the majority are fabulous and i would trust them to do much more before making contact. most of the time they ask me for the orders they know i would give, because they're good at what they do. anyway, thanks for the insight on how things are run where you are! it's always cool to learn about that:)

MassED, BSN, RN · Nov 9, 2009

I know this is an older post, but aren't there paramedics on EMS (depending on county, city, etc), to eliminate the need for this MICN cert? Seems like a pointless certification, and something that in most places, nurses already perform these functions in an ER.