Ellen in Ont

For the first time in our ICU, last month we signed a workload grievance. When we recognize the conditions are unsafe, and we have gone through all the channels to correct this, the workload grievance shifts the blame back to the hospital. The staff who signed it now have to have a meeting with the union and administration to deal with the issue. We still haven't had this meeting however. This doesn't fix the workload that shift or result in any immediate fix, but it is the only way to move for change that the hospital will sometimes listen to. That night we had 6 patients, five of whom were vented and the sixth was a fresh post-op who was extubated after just a couple of hours to put the ventilator on someone else - we only have 5 vents in the hospital. We only had three staff after 11:00 pm (the RT also leaves at 11:00). The only way we made it through the shift uneventfully was that WE WERE LUCKY! If any of the patients had started crashing, it would tie up at least two of the three staff leaving the other one to handle the whole unit. Luckily it was an unusually quiet night and everyone was stable.

In our hospital all RN's remove JP's, hemovac's, sump drains and penrose's as well as all types of sutures, central lines, arterial lines and epidurals. We do have policies for all of these and are watched for the first one. I thought this was standard nursing procedures everywhere? One thing to watch for when removing retention sutures, if it looks like there is a lot of tension on them, I start by removing every second one. If the wound looks like it might open I stop and report this to the doctor. I also sometimes use steristrips in place of the ones I removed if it looks like there is still tension on the wound edges.

Our hospital is a "quiet hospital" which means the overhead paging system is only used for the different codes. We have code blue followed by the room number, code pink for a pediatric code, code red for fire, code yellow for missing patient followed by a description, code black for a bomb threat, code green for evacuation etc. The only other thing announced is nurse assistance followed by the unit (that unit needs nursing help for up to two hours and any unit who can send someone does) or nurse alert (which means a nursing emergency and they need nurses stat for a short time). It is a big shock to go to other hospitals where the paging system is used almost constantly. I appreciate the quiet in ours even more. We do use the code blue even in ICU because other staff also come to all codes (RTs, ER nurse (usually records there), security (can act as runners if needed) and pastoral care to sit with the family). Instead of the overhead we use the phones or pagers for everything else.

The only premixed IV fluids we use are Lidocaine and Heparin. Everything else we mix ourselves. KCL is treated no differently than any other drug in our stock cupbaord and is even kept on the shelf beside the 10 and 30cc bottles of NS and sterile water. This has always made me a little nervous. Now I think I will ask about at least having it moved to a separate location.

I agree completely. They are totally different and have completely different focuses. If you really want ICU then apply for your apprenticeship there. It will go a long way in getting a job there when you are finished. It will also give you a feel for the ICU and help you to decide if that is the area for you.

In our hospital any potent drips have to be administered in the ICU. However, we don't have any other unit (telemetry or cardiac) to put them besides out to the regular Medical floor when stable. :)

Nurses in our hospital are paying $25 each to go to a supper where everyone will nominate nurses they believe deserve special recognition. These will be posted on the walls at dinner. We will also be having an "open mike" to relate our favourite funny nursing story. We will also be displaying some old nursing memorabialia (old uniforms, nursing exams etc). It sounds like it's going to be fun!

I think I am in my dream job (ICU/CCU) but if I can make it a dream, I would like the respect of doctors and the public, and be paid enough enough that I feel it is a fair wage for all I do. If I was REALLY shooting for the moon, I would include getting all my breaks!

I agree!! This expresses the feelings of every nurse I know. Good luck with your efforts to win your wage increase in BC. We in Ontario are watching.

In our hospital they have a different twist on the same theme. If they can't staff a unit for the next shift, they have "manditory call-in". If no one wants to work the shift, they start at the bottom of the seniority list and the first nurse who answers the phone has to go to work under threat of being fired. The only excuses to let her (or him) off the hook are inability to find a baby-sitter, intoxicated (which only works if it is a last minute call) or illness. This has resulted in the whole staff being afraid to answer their phones, having to screen all their calls, or getting family to lie and say they are not home. I know an instance where a nurse was on vacation, had her car packed ready to leave town, the whole family on the way out to the car and she made the mistake of answering the phone. She had to go work and the family did not take it well (can you blame them). We are just starting to fight back and some staff are now starting to refuse rather than lie. So far there have been no repercussions. Our union is presently looking into the whole issue.