AdvTechSondra

1: what level of care does your unit provide? (do you have a cardiac surgery program? do you have an ecls/crrt program? do you have a transport team? transplants? neurosurgery? complex ent? trauma?) we do everything except ecmo and transplants 2: how many beds do you have? what is your usual nurse to patient ratio? we have 26 beds, typical is 1rn:2pts obviously if they are more acute then 1:1 or even 2rn's:1pt 3: does your unit employ ancillary staff such as cnas or patient care techs to assist with hands-on care or is the nurse responsible for total care of the patient(s)? we do not use cna's or techs, we have two secretary's during the day and 1 at night but no direct pt contact. 4: how do you manage breaks in your unit? here's an area we are truly lacking... we don't get breaks, we eat lunch/breakfast and dinner in the unit, another nurse watches our pt while we run downstairs to get food in the cafeteria. 5: how is continuing education provided in your unit? we have 2 unit educators who are responsible for orientation as well as disseminating information to our staff....monthly "policy updates" pals, skills and stuff like that but any serious ce is pretty much on your own. 6: does your unit hire new grads? what kind of orientation program are they given? we do hire new grads, however we try to keep it to 1-2/year. they are given a minimum of 12week orientation and then depending on how they're doing it's often extended. 7: how difficult is it to transfer patients out to other levels of care when they're ready? do you ever discharge patients home from your picu? our issue with transfering out is only limited by space available. today for example we ended up sending 4 patients directly home because for the past few days there haven't been beds available in the general care areas. 8: what is your turnover like? our average length of stay is 3.5 days for the patients, obviously we have a few that are weeks and many that are overnight. hope this helps, the more data the better.

We do ECMO in both the PICU and CICU, mostly the PICU

I hope this thread is still current. We started our CRRT program nearly 5 years ago in our PICU. I kinda felt like someone who was given the task of starting a lemonade stand who had to build the stand, grow the lemons figure out how to make lemonade and recriut and train employees to make/sell it. Our program has come a long way and still has a long way to go before I can say it's a Great Lemonade Stand! Several things about the original post are alarming. But hopefully they've been resolved. We use the BBraun Diapact machine, utilize Citrate and Calcium for anticoagulation, and use either NormoCarb or a Customized formula in 3 liter bags for dialysate/replacement fluids. CVVH is ordered and maintained by the Nephrologist (not always the best) and we have a team of 25-30 nurses trained in running a patient on CVVH as well as priming and setting up the machines 'Divas' as we like to refer to ourselves. I have found that actually, priming and troubleshooting the priming process has created nurses who are much better at troubleshooting at patient and have a fuller comprehension and understanding of the process. We always staff CVVH patients as 1:1's with an occasional 2RN's:1 when the patient is very unstable. There is always a 'Diva on Call' 24/7 and the team is great about helping each other out. I would love to have a group of other PICU or even adult ICU nurses to talk to about CVVH or CRRT to get some insight into how things work for you. Thanks for listening to me chat.

I've been a PICU nurse for a little more than 11 yrs and like others have seen one or two 'addicts' also with other issues. I feel that on the whole most 'good' PICU nurses are a little OCD, Perfectionist and pay close attention to detail...these characteristics make us who we are, and allow us to do the job we've chosen and to love it (most days). I think working in PICU exposes you to an enormous amount of stress and brings all your fears to the forefront concerning your children and family, and not learning a healthy way to deal with those issues can lead to your demise both professionally and personally. So, for me at least the key has been to do some 'self assesment' and give myself permission to grieve, rest and think about anything but work. That manager is obviously speaking out of her own fear.... if PICU is where you want to be, go for it!!