cloggs

I think one of the fundamental probelms is that our unit is surgeon led, we don't have intensivists only theatre anaesthetists. The newer ones are concerned at times and glad we are trying to develop the unit. I have recently been appointed to the BACCN committee for the region and one of the anaestheists is very supportive in relation to the study events planned. Our nurse practitioners have CCU backgrounds and know little in relation to vents - they admit this themselves. Despite my recent moan I have loved working on the unit. Staff in general are very supportive and we have a great mix of overseas nurses with alot of experience. It's exciting to be part of a team that can advance practice if allowed. Guess I will have to try and iron things out with vent supremo but don't want to drag colleagues in. I need someone to be present in a meeting who is objective however so may ask my union rep. I feel sorry for him as he is 73yrs old and has a lot of experience but we can only take this into consideration to a certain point! Heather.

I didn't apply for the band 6 post which now has someone appointed, but I have worked in senior posts previously.I have tried very hard with the vent supremo but he does not wish to discuss things with myself if I produce evidence to substantiate my points. New staff have a brief tick box generic competency package which no one follows up to see if it has been completed.Time after time I encounter innapropriate settings. Last week a patient was 'weaned' from ASB of 20 to 11 in less than 12hrs and I was asked to rest them overnight by reducing her to 10! No one reacted to her very reduced tidal volumes and increasingly high resp rate. Needless to say her support was promptly increased. I hope I don't sound sanctimonious as normally I am not outspoken at work and get on well with colleagues but this has made me despair. I have already applied for band 6 post elsewhere but would like to resolve this. Unfortunately, I am on 2wks A/L so cannot follow this up immediately. Thanks for your comments folks. It's good to let off steam.

I have recently been appointed as trainer for drager ventilators within my cicu. To my surprise and disbelief my managers have told me in no uncertain terms that it is not in my role to teach staff any more than how to switch the vent on, which tubes are used and which buttons to press to change settings! Knowlege of ventilation on our unit is very poor. I feel dissapointed as so many staff have asked me to teach them about ventilation, even a surgical reg. 3 of my colleagues have also been told the same and it appears to be related to the fact that a nurse who has been responsible for this area for many years is feeling threatened by us. There has been opposition to us producing a new resource file even though the one in existence has articles no more recent than 1995! We have no ventilator competencies as the said person has been 'producing' them for the past 4 yrs. I am very sensitive to colleague's needs and egos and am not the type to force my views but am frustrated at the general managerial approach in relation to this. I have worked on the unit nearly 2 years and have recently been asked to apply for a band 6 post, but am totally perplexed by this 'gagging order'. Am I being uber sensitive or does anyone else feel this situation is odd? :angryfire

Hi. There should be a wealth of info available. You could consider the use of Aricept etc, person centred care (Bradford Uni have alot of info), family support, Admiral nurses, assessment techniques, respite care, day care support, crossroads, lack of practical support, social stigma, role of CPN. Good luck, Heather :wink2:

Hi. I have only worked a few shifts in private prisons in the UK for an agency. The facilities were excellent and nurses were well supported.There were never any prisoners in the hospital bays - the work involved administering medication, Hep B injections for new arrivals, sitting in with Drs. and assessing patients who had requested to see the Dr. Where I live they frequently advertise for prison nurses in the Govt sector. I work with alot of overseas nurses (in hospital) who are brilliant and have alot to offer so am sure they would welcome you providing you have a thorough personal history check. Good Luck. Heather.

Hi. I am dualled trained and worked for approx 12 years in mental health before changing direction and returned to adult. I felt passionate about patient care and particularly enjoyed the older client group but was continually dismayed by staff attitudes towards patients. The focus appeared to be centred around staff needs as opposed to patients. I did have a very positive time working with a brill team in community however. It is now several years since I worked solely in mental health and feel sure things must have improved considerably. I did work bank shifts at different placements approx 3yrs ago where staff either complained they couldn't stand the job or simply failed to treat the patients with any hint of respect or dignity. I would not now consider returning to mental health as I love my current job.

Hi Jenze,I work on a cardiac intensive care unit and we have been involved with the productive ward for several months. Currently working on handovers I believe. I am not part of the working group but obviously am involved to a degree. Any questions feel free to ask. Regards, Heather

Thanks for feedback. My concern was the possibility of VILI if tidal volumes are high as current research seems to indicate considerable risk. We are advised to use 6-8mls per kg but often see higher tidal volumes.I acknowledge that most of our patients are ventilated for a few hours only but we also get long term vented- up to a year! Bipap on the Draegar vents just seems more appropriate than volume and the newer anethestists tend to use this mode. Guess I will just have to get used to the differences between general and cardiac icu.

Hi Everyone. I am from the U.K. and wondered what ventilation modes are used on patients post CABG in your units. Having previously worked in general ICU where pressure modes dominated I am finding it unusal that most anethetists use volume. Little regard is given to high tidal volmes. Any feedback appreciated.