Kimmy_RN

Those who CAN'T DO.. CARRY A CLIPBOARD! I would have loved to have seen how they would have reacted to my actions if it was THEIR family member in that bed! We are notorious for "practicing medicine" on nights. We have a LOT of autonomy on our units on nights because the drs and surgeons trust us to do what's best for their patients. They know we have the skills and brains. They do NOT let green nurses, newbies, or idiots take care of their patients. They will literally say, when wheeling the patient out from the CVOR, "DO NOT let, ***** take care of my patient!" We are currently re-writing our ECMO protocols right now w/ one of our Intensivists and CT Surgeons. This is a process.. but I'm very optimistic on where it's going. Our CM highly encouraged the "CLIPBOARD NURSES" to attend as well.

I strongly encourage you to be a tracer on a patient who is undergoing complex heart surgery from preop through the postop or PACU phase. That way you see everything a patient goes through and what the staff are mindful of when they're caring for and stabilizing this patient. If your facility allows this.. do it. At the very least.. shadow a CVICU Nurse for a couple of shifts.. to see what really goes on with the patient's when the docs aren't around. Familiarize yourself with postop heart hemodynamics, Swans, heart rhythms, CRRT, epicardial pacing, chest tubes, and the unit's protocols for emergency management of open hearts. For a dessert.. maybe brush up on ECMO! I Love CVICU.

Thank you! I appreciate your fire! Btw.. it was A-V. I will let you know how this unfolds. We have 3 of our pts on ECMO right now in the unit. I will chat this up with my Nurse buddies.

We are a small CSU of 9 beds. Our hospital was recently surveyed by JCAHO. Of course, they picked our most critical ECMO patient to hover around. When the patient's BP tanked, we were cited for practicing medicine without a license because we did not follow standard titration protocol. (We titrated pressors quickly to keep the patient alive.) Of course there was a big.. calling on the carpet.. meeting about this.. and JCAHO reps said Unless you have a Drs order to titrate that quickly, you may not! Do your CCU's or CVICU's have any emergency titration protocols or IV sets to protect you? Standard titration rates are ridiculous when BP is 44/20 and HR just dropped 20 pts and your CI is now 0.7. Just saying. Thank you for your help and suggestions.

We are a small CSU of 9 beds.. our patients are the sickest of the sick. We cleaned out a storage room on our Unit and got it approved for a respite room. We have a couch, lamp, rug, end table, and massage chair in there. If someone needs to doze, they have someone babysit their patient while they clock out to nap. If there's an emgergency.. we grab them right quick. This works well for us. I rarely need a nap.. but once in a while.. life happens and you've been up for 48 hours. Our surgeons have Sleep rooms.. so we made one for our nurses! Maybe something like this would work on your unit?

Sounds like they are healthy enough to be discharged! Our hospital has zero tolerance policy of threats by patients.

We've gotten patients back in a code situation after giving CaCl.. we use it as protocol on our unit for anyone with an ionized calcium

I would NOT take that job! In California, that pay rate is horrible, especially if you're working nights. Is that GN rate? If you have experience in ICU, you should be paid based on your years of experience AND any certifications (ie, CCRN). If you have NEVER worked ICU, I highly recommend against your working contract ICU. You will crash and burn, my friend. I'm employed in FL, and my pay rate is almost double that, uncontracted!