BrandonB779

Hello All! Reaching out to my AllNurses audience for some help. I am researching whether or not formal Crisis Intervention Training (CPI as it's called here) for our ICU nurses should be offered. Now there is a cost associated with this because it is a training and certificate program; however our hospital has had a few incidents in the past few months with psychiatric alerts to our ICU (family members included) where we've brought up the issue of safety and trying to have formal training including de-escalation techniques. Does anyone out in the forum world have CPI training in the ICU setting? If so do you feel that is is helpful / worth the cost and training time? Does your institution make it mandatory outside of psychiatric nursing units? (Currently only ED, and Psych RNs have it as mandatory). I am looking for as much SOLID data that I can present to a group that includes the Vice-President of Nursing for our hospital; so please if you have any specifics including studies or data you've research and are willing to share it would be greatly appreciated! Always looking to keep my fellow co-workers safe! Thanks everyone! Brandon

To add some humor, I took a tactical-medic class (TCCC protocols) and one of the instructors instantly had a new nickname for me: Focker, I laugh about it, and Murse, only a few medics I work with will throw it out and say "oh he's a murse" but past that, no biggie.....it is what it is.....but here's my thought....could always be worse

I graduated 2 years ago from Nursing School, and much like the first reply you saw, yea its a completely different unfair world lol. The GPA hit, happened, the stress, happened. Best advice I can say, ask questions, get rationals, don't think too much into the questions when it comes to test time. There are usually the 2 great answers, then the 2 that make absolutely no sense. Don't read into much of anything, accept it for what it is, and be mindful of your clinical experience as well. In the program I was in, if you had a mistake on the floor (the instructors checked everything from day 1 before you administered it) and it was a serious offense, you were gone.....and never allowed to re-apply. Make friends and study, it will honestly keep you afloat, and designate your time. Don't try to work like I did (it sucked) it's not recommended to try to balance a work load and classes. Best of luck!

I wish we had that luxury, unfortunately we don't always. There is a hospital policy that doesn't really allow for transfers unless push comes to shove (anytime between like 1a-5a) and most of the time they don't transfer people anyways. The ones that "seem" stable by MD eyes and really are just here as boarders...end up on the floor for a few days. I wish we could triage down, but again like I stated, if the stepdown ICA unit is full, and we have an open bed....welcome to the MICU lol. We unfortunately don't have the staff to keep many open beds at beginning of shift, avg 5 nurses days, 5 nurses nights (6 is a god send, and 4 is a bad day) for 16 beds. Were budgeted for 6, but as I said, its a godsend if we get that many on lol.

So I figured I should add my 2 cents into this since I've been on/off about joining the military w/ specifics to the AF since I was a young kid. Now I've graduated a Diploma RN program and currently finishing up gathering my BSN. I have as of this moment 2 years Med/Cardiac ICU experience (straight outta school hired) and my ultimate goal is to be a critical care flight nurse (either AF or civilian sector). In addition I've got ACLS, PALS, NRP, TNCC, TCCC, BLS (Instructor), Hazmat Ops & Communications, in addition to NIMS 1,2,7 and 8. Any thoughts/guidance/help? Thanks!

So here's a question I've been wanting to pose for some time and get some feedback from some fellow RNs. I work in a 16 bed Medical/Cardiac Critical Care Unit. What happens when the ICU is at capacity between staff and patients waiting to be admitted to the unit? The hospital I work at has a seperate designated Burn Unit that doesnt take MICU/CICU patients (only one in the state, and within a 100-150 mile radius I believe) and also a seperate SICU that sometimes gets our overflow patients. It sometimes happens on nights where if a Code is on the floor, it has to come to us (99% of the time if they survive), or if the step down unit is full (ICA) and they are pending ER admissions and we have room, they usually take our last open bed and also expect us to take a code or a ICU admit as well.....sometimes with on call available, sometimes not....suggestions/thoughts? Looking for some input, thanks!

We have started doing bedside shift change report in a 16 bed MICU. People have done it for a while prior to it getting implemented and required, others have the "old habits die hard" feeling, etc. MedScape just put out an article from research saying it has improved patient/staff relations, and also allowed for more thorough report from staff members because you may see something you forget if you were away from the room. It's difficult because many of our patients are usually intubated/sedated; and family not always present. But yet when they are present and can contribute to the report or understand things a bit better, it does seem to create a better whole picture amongst all individuals.

Couldn't have said it better. New grad into MICU myself now 1 1/2 years in, definitely keep parameters tight, dont drone out the "alarms" or "noises" pay attention, ask questions, and clarify what you dont know, and not implying that anyone will but I know a few new grads who have.....remember not to get cocky....it will come back to bite you.

Well I'd say first day on the floor, take the time to let your preceptor explain everything to you....they're going to have a wealth of knowledge and you should be familiar with your settings. The basics of each system dont change with ICU care, some just more in depth, and let them explain the ways that things will happen. I'd say what you should to do be competent, is dont be too over zealous or confident, ask the questions you need answers to; they understand its a first day, so they'll be prepared for it. And in terms of looking like an idiot, no worries; long as you just go with the flow and take it step by step.

In all honesty I will say it may be difficult for me to give you advice on how to do a thorough and more full approach to a patient assessment; but here's best I will try to offer: First, make sure to obviously focus on the big picture of why they're admitted in the first place, but dont overlook complications or the smaller less obvious clues/hints. Personally for me depends on how my patient is once you walk into the room (vented and sedated/awake) and that right there is half your neuro assessment lol. But figure out how your hospital approachs the patient assesment whether its a reference to the documentation and our rounds with the residents and attendings. It can be slightly frightening going to ICU as a new grad RN trust me (did it straight from a diploma based program); but there will be guidance on the way. Get a hold on the fundamentals you know, and let your preceptor guide you along the way. In terms of nights, well get yourself into a healthy sleeping schedule; try to make it as close to what you would do on days, just reversed (i.e sleep x amt of hours, activities, then work, or w/e your schedule used to be). Coffee always helps, and the adjustment takes time, but you'll get the hang of it. Hope this slightly helps you, any other thoughts/concerns, reply, I'll do what I can to help you, currently a MICU RN (nights!) straight from school in 2011... Oh and this: Kudos on the New Grad ICU position, hard to come by!

MICU RN for 1 1/2 years now, we generally have 2:1 ration, with specfiics on 1:1 criteria for care (multiple pressor titration, IABP, Protective Hypothermia, or really really crashing) but we have done 3:1 usually with our step-down patients or those that are good to be transferred. When push comes to shove, it just happens.

I will add to this, I dont have a BSN, and work critical care new grad fresh out of school with a Diploma in nursing. All hospitals are definitely proving to want to go towards BSN's, but remember its also what you make yourself in the interview and what you have in experience that can help you, its somethings people dont always look at.

Our hospital puts our insulin drips mixed in pharmacy, but in D5 not D10......and it gets titrated each hour based on hourly glucose checks.....

At our hospitals policy, anytime an order for fluids or IVs are started there is an automatic policy for flushes Q8 hours in our medication administration record so that we can keep veins patent in comparison to KVO IVs at 5 mL/hour.

I find it quite interesting that alot of hospitals will specify jobs (especially with alot of the applications online now) that like "New Grads Not Accepted, or Will Not Be Considered" but then others that have no indication of it on the application and when it gets submitted they call back saying sorry not experienced enough. I dont know if its just regional around here in New England but alot of places I've heard from people dont like to hire new grads, and even some Med/Surg places are being sticklers about it, and some people without experience are going straight into Nursing Home or other sub acute areas for practice.