traumasurgRN

I would be very careful when entering MD orders prior to speaking with the MD; here in SC, this is outside of our scope of practice, unless it is being ordered under a protocol or standing order. In my facility, we do have some protocols and standing orders which we can utilize for certain labs and such, and as a Rapid Response nurse, I have my own separate protocol which I follow and allows me to order labs, EKG's and nitro for chest pain. For my first 2 years of ICU nursing, I too was taught that it was an expectation to order labs, etc and obtain results, if possible, before calling the MD; however, upon being floated to another ICU in the same hospital, this was not the expectation, and I was punished for doing so, because another nurse felt compelled to alert her director about my practicing outside of my scope. I have ben told many many times by the surgeons in my unit that we can write and do whatever we need to keep the pt alive, and they would sign off on it in the AM, however, I act with extreme caution in doing so. Once bitten, twice shy I suppose.

I have never heard of this either, and I would be very hesitant to administer and manage this gtt.

The average day for a trauma ICU nurse is not much different than that of any ICU nurse. Get report, assess the pt, give meds, turn, pt care,turn, assess, turn,give meds, assess and turn haha. Most people think that icu nursing, and especially trauma ICU nursing is always high octane, adrenaline filled, all the time, but most days you will find can be very routine, and those are the days you will appreciate after having a high octane, adrenaline filled day. In the trauma ICU, you can expect to have pts with many IV lines, chest tubes, tons of fluid resuscitation, and having to manage any other co morbidities they may have. You more than likely will have pts with frequent neuro checks, spinal precautions, and even Ventrics if they have severe head injuries. Trauma ICU nursing is great, and its definitely a speciality, but at the same time, you must be a jack of all trades, because trauma can affect pts of all ages, and often just complicates any health problems the pt had before the injury.

I work in a level 2 Trauma ICU, though we more often function as a level 1. Our hospitals RR system is based out of my unit. To be eligible to serve as the RR nurse, you one must have 2 years of ICU experience and be ready to train for the position of Charge Nurse in the unit. I have recently started serving on the RR team, and I have 2 years of trauma experience. I feel that I am competent enough to perform the job, however, when compared to the more senior members of the team, I still see areas in which I am lacking. There is no way I would have been ready to serve on the team with only a years experience, and I too put in many hours my first year. There is no substitution for years experience. When you respond to a RR call, you never know the severity of the situation that you are walking into, and unlike being in the unit, you often do not have other critical care nurses to back you up and be a resource; you are the resource and the expert opinion. I am not saying you are not ready for the job, I just feel that a system that allows nurses with only a year of experience to serve as that expert opinion, is not a safe system.

Hi, I have recently been offered an interview in the Behavioral Health facility that my current hospital also owns. I started in a level 2 trauma ICU right out of nursing school, and recently joined the Rapid Response team, so critical care nursing is all I know. I know that it will be a big change of pace going from ICU to psych, have any of you made this transition or a similar transition? How difficult was it for you to move from one specialty to another totally different specialty?

New Hanover Regional Medical Center in Wilmington, NC is a level 2 trauma center...

Nimodipine is another important neuro drug to know. It helps increase blood flow to injured brain tissue. Its taken orally or down an OGT/NGT. NEVER aspirate it and try to push it IV, pushing it IV can cause your patient to arrest. Even though many bleeds are caused by HTN, remember that you don't want to keep their BP/MAP to low, you want to maintain adequate perfusion to the brain tissues, se be careful with the antihypertensives.

I don't know about FNP's, but at one time, we had an ANP that worked for our intensivist service. She has since moved into another area of the hospital, and an ACNP has filled her role. We have had FNP's to work as hospitalists, which at times, make rounds on patients in the ICU's but did not work as an intensivist only.

I currently work in a Trauma-Surgical ICU, our hospital is a level 2 trauma center. I have been in the ICU for almost 8 months now. I am considering picking up a PRN job at a neighboring hospital's er, they are a level 3 trauma center. How difficult would it be for someone with my trauma icu experience to transition to ER nursing?

This may be a dumb question, but I am slightly confused as to what the requirements are to gain the CCEMT-P certification. I may be reading it wrong, but does one have to be an actual EMT before gaining this? I have seen in some places online that nurses can gain this certification, but do they have to be an EMT also? I am interested in Critical Care Transport, and I have seen that the major teaching hospital in my state requires this cert to do Adult CC Transport.

This sounds very similar to the Rapid Response team at my hospital. Our team does many of the same duties, we also round on patients who have a PCA to make sure settings are correct and the documentation is correct. Our team is based out of our trauma surgical icu, but several of our team members have experience in other areas such as MICU and ER. I am not sure of any specific stats, but I have been told that the umber of unexpected unit transfers have been drastically cut down since the initiation of a dedicated RRT.

I find it strange that you are sedating a Neuro patient, how are you then getting an accurate neuro check out of them, especially if they had deficits before the sedation?? Our neurosurgeons RARELY order sedation for their preop or postop patients, and if by some chance they do order sedation, its is usually a very small dose of propofol. They discourage the use of prn ativan unless it is very much needed, like hx of etoh. We even had a neurosurgeon refuse to order a 1x dose of iv benedryl for a patient with a small SDH, even though the were a&o x3.

In my unit, the primary care nurse documents on our assessment flowsheets, and any documents as directed by our facility. We do not write progress notes in the chart. Several of the different specialties have their own forms or format in which they want to use for their progress notes. Only the MD or their rounding RN writes these progress notes. If the primary MD consults another MD, the consult is given to their RN, and the RN sees them first to gather pertinent info and needs for that patient, then the MD will see the pt unless it is a stat consult.

Tewdles, the rounding RN's that I am speaking of work the same way, within a protocol or order set between the nurses and the MD. I did not mean to imply that the RN's were practicing outside of their scope or illegally practicing medicine. I simply was curious if this was common among other facilities.

Just like meandragonbrett said, they work in contact with the MD, not the hospital. More often than not, the nurse is usually rounding with the MD, or just a matter of a few hours before. I understand that this is usually the job of the APN.