ccrnjen

I have to second the vote for the Hollister AnchorFast. We trailed several different kinds and this is by far the favorite. It is super easy to do oral care, prevents skin breakdown and does not need to be changed frequently. Our policy is to move the tube (right, left, midline) q2h when doing oral care and turning the patient. If we turn our patients q2h to prevent skin breakdown on the tush, why not move the tube to prevent breakdown of the lips? This is the only device that makes repositioning the tube easy and safe.

That is awesome! This is the way I think the pay scale should look for RN's. Do you have any idea what departments are on each tier - particularly the 2nd and 3rd tiers? Just to know where I am coming from, the current hospital I work at has the same pay grades for all nurses, differentials for nights and evenings. No differential or increase in pay for ICU, BSN or certification. They do reimburse for the CCRN exam fee and give an annual bonus for each certification which varies depending on how good the year was. Typically between $250-500. For those doing math, that works out to about 0.12-0.24 per hour. Thank you everyone for your posts, keep them coming! The more ammo and info I can gather, the better!!!!

Along the lines of a previous thread, I am interested in whether your institution has additional pay or differentials for critical care nurses, ICU nurses, BSN, certifications (particularly CCRN), etc. It has always bothered me that some places have the same pay scale for all nurses, regardless of level of training and education. I whole-heartedly agree that there are excellent nurses in all areas of the field and that each area is specialized in its own way. However, it is the ICU nurse that is called upon to take the patients that are too sick for the floor, to respond to codes, to respond to MRT calls, etc. It also seems that often ICU nurses are required to float to any other unit in the hospital while floor nurses are not able to reciprocate that and float to an ICU setting. I am in the process of gathering information on the compensation for ICU nurses to present to management and would appreciate any help you can give. Thanks in advance!

Depends on the audience you are presenting to.... I have always found interventional cardiology fascinating. The technology involved, the advancements made, current trends and devices... I still think it is amazing to see a blocked or narrowed artery re-opened. Or PFO closure that is now done in the cath lab in many places. What about something on ablation therapy for arrhythmias? However, these topics may be to "simple" for your audience.

Monitors do not always provide an accurate reading, particularly when there is respiratory artifact on the waveform. In order to get the most accurate reading, CVP should be read during the end-exhalation phase of breathing, when intrathoracic pressure is "zero". That is, there is not negative pressure for inhalation or positive pressure during exhalation (or vice versa on the ventilated patient). The CVP waveform consists of three waves (A, C, V). The 2 most accepted ways to obtain a CVP reading are to take the mean of the A wave, or find the z-point. Because determining which wave is the A wave can be difficult, especially for newer nurses, and because of abnormal rhythms (a-fib, AV dissociation) and physiologic abnormalities , I think using the z-point method is easiest. The z-point is found at the end of the QRS, just before the C wave (which represents tricuspid valve closure). It is a good indicator of right ventricular end diastolic pressure. To do this, make sure your transducer is at the phlebostatic axis and zeroed to atmospheric pressure. The head of the bed can be up to 30 degrees. Print a strip of your ECG and CVP waveforms, determine exhalation on the respiratory cycle, taking into account whether your patient is spontaneously breathing or on a vent (remember that exhalation is almost always longer than inhalation). Draw a line from the end of the QRS down to the CVP waveform and take the reading (be sure to check the scale!) - best to average a few. When this is done, you shouldn't have a negative number which is usually caused by negative intrathoracic pressure. All this said, many clinicians simply trend CVP measurement and treat it (or end treatment) when it has changed significantly. However, if there is significant respiratory artifact, you could be over- or under- treating your patient based on a "false" reading. Hope this helps and doesn't confuse things!

I would like to know what everyone does with post-op carotid endartectomy patients. Do they always go to an ICU? Only the ones with high blood pressure? How long are their hospital stays? What about carotid artery stenting (done in radiology)? Are these patients treated any differently (aside from routine post-arteriogram care) than the standard OR carotids? Thanks for the info!

Had this very issue come up at work today. I was always taught to base titrations on the dry weight - or rather - the pt's admit weight. Weight changes, particularly weight gains that we see so often, is usually a result of fluid and third spacing. This fluid does nothing to metabolize, utilize or store the medications.

I went from a hospital that used the Alaris pumps as well and was lost when I had to calculate out all my drips. Here's the equations I found that work: 1ml/hr = ? mcg/min = (mg in bag)(1000 to get mcg)/ (ml in bag)(60min) Divide the above by kg to get mcg/kg/min 1mcg/min = ? ml/hr = (ml in bag)(60min)/(mg in bag)(1000) Multiply above to get mcg/kg/min On both, if you want the dose as mg, not mcg, leave out the 1000 portion. If you want the dose per hour, not per minute, leave out the 60 portion. So if you want to know what your dose is when you know the pump is set at 10ml/hr - use the first equation and multiply by 10 If you want to know what to set your pump at to get the correct dose - say 5mcg/kg/min, use the second equation and multiply by 5 Does this help any??

I believe you are talking about triple flexion: Flexion at the hip, knee, and ankle, in response to stimulation of the sole of the foot. Typical of lesions of the pons. It is sometimes seen in brain death, but does not mean the patient has brain stem function. Can also be seen spinal cord injuries as it is a spinal reflex. Does this help?

After having spent a good amount of time as a preceptor for new nurses to ICU, the difference between a new grad and a more experienced nurse who is new to the ICU setting is huge. I feel that nursing school does very little to prepare you for what nursing is really about. As a result, new grads have a huge learning curve - just to become a nurse. Many of the daily tasks and skills have never been done by the new grad. Much of their time is spent learning the "tasky stuff". How can we expect them to even begin to critically think when they are focused on completing tasks, developing basic nursing skills and getting organized?? The nurse who has spent time on the floor not only has their organization and skills developed, but now has time to begin to critically think about what their patients are going through and the pathophysiology involved - only now it is a much less critical/stressful situation. When these nurses come to the ICU, they can pick up the new tasks quickly and spend a lot more time thinking about the "why's", developing the knowledge to become good ICU nurses. That being said, I truly feel that new grads have no place in the ICU. However, because of the current situation, we seem to be stuck with this. I do believe with the right orientation, preceptorship, mentoring and desire to learn, new grads can be successful in the ICU and it is our job to help them to succeed so we aren't saving their butts or cleaning up after their messes every day. On a side note of this discussion, I agree that it takes at least a year for a nurse to begin (notice I said begin) to feel comfortable in the ICU. It makes me absolutely ill to see these people with only 2 or 3 years experience, who think they now know it all, training the new grads or taking charge. Is it any wonder that many new grads do not get the training they need from their preceptors?? How can somebody with so little experience in such a demanding field be expected to adequately teach others or actually be the resource person for the entire unit?! Maybe this is just my experiences with ICU coming into play. When I started, nurses had to be on med/surg for a year before going to a telemetry or step down type unit, where they spent a year before applying to ICU. Typically nurses had to be in ICU for about 4-5 years before they were even considered to be a preceptor and another year before they were placed in charge. If only we had that luxury now.....

Try doing a search on google - hypothermia cardiac arrest. you can also add protocol or policy to get more detailed info instead of just the research. There seem to be several that are available online. Hope this helps!

I don't know about the specific legalities involved in this - I would check AACN's site to see if they have any guidelines as they are probably your best resource. Your BON may have something. From my experience, whenever the census is down, we had a policy that if there was 1 patient, there must be 2 staff - it's been a long time, but I'm pretty sure it was 2 RN's. Not only for basic care issues - turning, etc - but also for the case of a pt going down hill quickly or coding. I would be worried if I was you - I do believe this is a patient safety issue. Good luck finding the support you need to get things changed!

Many of you have great ideas - a few more that come to mind: -Make sure they don't put carpet in the hallways!! Seems obvious, but to them, it reduces noise. To us - it's a back killer trying to push beds (esp those with our larger patients!) -Make sure the rooms are large enough, not only for all of the equipment that the patient will need and for nurses to operate, but so there is an area families can be that is out of the way (have seen both rooms that are wider or longer to accomodate this - it helps!) -Plenty of outlets! Think 2 for bed, 1 for each IV pump, 1-2 for vents/bipap, compression stockings, bair hugger/cooling blanket, the monitor, feeding pump (if different from iv pump), etc. -Plenty of suction, especially with the subglottic ETT suctions becoming more popular - 5-6 per room would be ideal! -Private bathrooms for each room - patient satisfaction and reduces possiblity of cross-contamination from sharing with the neighbor. -Think of everything you want handy or need in the room and make sure it is encorporated and not cramped - sinks, supply carts, linen storage, med drawers/cabinets, charting areas, counterspace for supplies, room for recliner/chair for the more mobile patients, phones, ....... -One other thing - for the locks on the med cabinets/drawers - keys are cumbersome, get lost, and are hard to use without contaminating in isolation rooms. Push button combinations that self lock when close are best. Good luck!

I completely agree! I'm healthy and I bathe once a day. If I'm sick, I'm lucky if I feel good enough to bathe once a day. Twice a day, even if someone was doing it for me, would make me miserable! I think changing sheets when they are wet or soiled, wiping and sometimes lotioning backs when turning, wiping faces in the morning, and providing proper peri-care should be sufficient between q night baths.

I have worked in units with both strict visiting hours that were adhered to for all patients except the dying and peds and those with 100% open visiting. Also worked in a unit going through the transition from limited to open. The transition is a hard one to make, but I think most nurses adjust over time and I have not seen patient outcomes adversely affected. Families seem to appreciate the open visiting very much and we establish rules early on. I usually tell families that they can stay as long as they want as long as they keep the patient in mind. The patient is very sick, hence the need for ICU, and needs their rest. This is not a party or time to catch up with all the long-lost family, this can be done in the waiting rooms. I remind them that if the patient is sleeping, leave them be, and encourage immediate family to be the "gatekeepers" to speak for their loved one. We also discourage them from looking in each room they pass - to protect the privacy of those patients, just as they would want the same done for their loved one. I was truly amazed at how well families typically responded to the open visiting. They seemed to be more respectful of the patient - less of the "I'm only here for limited time and I must make sure the patient knows I'm here". They also are quite agreeable when we ask them to step out "to protect patient privacy" for baths, procedures, turning, etc. Again, the journey to open visiting is very painful and meets a lot of resistance, but we all learn to adjust. It's just another sign of the times and how things are changing constantly in our profession!