JeanOfAllTraits

This is my situation too. I'll be leaving my adult ICU float position for Peds PreOp/PACU. I'm excited buy also terrified of leaving what I know I good at, where my opinion is respected by other staff (even the ocassional Doc ) and going to a new hospital, new population and new area. But it's time. I've been dealing with a work related injury for nearly 18 months. It's time to pull away from the bedside while I still have a back!

Yes, Maggie, how DO they do that!

Well written. Sounds like last night minus a few changes to the source of the asystole. A well run code can be beautiful and seemless.

Three units, a 25 bed SICU, 18 bed MICU, 16 bed CVICU. MICU and SICU have 2 CNAs on and CVICU has one on. They help with turns, restocking linens, ordering supplies, doing baths, stripping room after a transfer and grabbing floor beds for transfer among so many other things. We'd sink without our CNAs.

If you want it and they are offering with a good orientation program, I'd say go for it!

I just had to pop in on the MICU side. I love our MICU. Yes, plenty of chronic geriatrics, but also plenty of younger acute issues. Things can go really wrong, PEs, septic emboli, suicide attempt with acetaminophen OD. Some of my sickest patients have been younger MICU patients. Our SICU and CVICU also have their share of chronic patients, admittedly MICU has more. What are you looking for in your patient population and what are your long term goals?

Forgive me, but I feel a bit confused. What access do you have to a PICU? Aome other things I'd ask wouls be: What is the process for moving a step down pt to a PICU bed? Who an admit to the step down bed?

Good for you. You showed strong critical thinking and clear a thorough understanding of pathophysiology. It seems to me that your hospital is squelchin your nursing practice. I think if you get in a facility that supports the nurses, you'll make a wonderful ICU nurse. A side note, if a pt's blood glucose was 70 and you have to ask the MD if you should hold the novolog or even the lantus, and the MD says to give it...that pt could easily become hypoglycemic which can have serious consequences. A hospital's policy of you bending to the whims of the MD does not protect you or your license from legal action.

Our intermediate care is 2:1 if there is super heavy or unstable and needing the ICU ASAP before we code otherwise it's 3:1. I've never seen ratio go above that, but my hospital is fantastic about ratios even though we're not union. Our IMC is 100% tele with a handful of stable trachea vents, some new from this admit some old trachs, some on PS/Bipap. They don't wean vent/PS setting but will do switching between vent and trace dome during the day. They take anybody who is needing Bipap apart from at night for OSA. It's a heavy and busy unit, sometimes 2 total cares with another IMC patient, but the team works very well together. The hardest thing is when the ICUs are full and we can't move patients to a higher level of care until we're at a rapid response or code situation.

Gastric residual volumes, the sound of retching/dry heaving and emesis in general and I are not friends. I sometimes get nauseates with my cycle and I have actually had to get another nurse to check residual volumes for me because I was literally gagging.

If you have an ART line, draw from there. However if you don't have one, then the PICC or your CVC is your only option besides a typical lab draw. I was taught to pause the other drips before drawimg the waste, them draw the lab, flush and start the infusions back up. If the patient isn't able to tolerate their drips being off thay long then they really should have an ART line anyways. All else fails, find a good vein and try a lab draw your self. :)

Different nurses have different sheets. Most use one basically blank sheet. I fold mine in half and use one side for each patient. Top half had past medical history amd current hospital course. Sometimes that current is everything that has happened, sometimes its the original reason for coming to the ICU and where they're at now. Bottom of the half sheet is for the current assessment. I like a system report and most of our nurses do too. I write sections for cardiac, respirator, neuro, gi, gu, skin, IV and "needs". I sometimes write allergies, usually code status. At the end of it all, the paper is a brain but the computer is the final back up (as long as my brain doesn't say something in the computer is wrong. ) what I don't write down is always on the computer.

I'm sure the story leaves out a lot of the information we in the medical community are hungry for. Oh well, we won't get it and will just have to be satisfied knowing that either we don't have all the info, or there is something greater than medical science at work. As a nurse of faith, I'm still gonna go with the former. My concern is that these stories give families false hope and make them feel like parental failure for giving up on a child who might have 'gotten a miracle' if we'd only tortured them a bit longer. The same goes for pediatric and adult ICUing as well.

I habe always said that the hardest unit I have ever worked on is our stepdown unit. Broad range of diagnoses, all the services in the hospital, the need to be hypervigilant and have keen assessment skills. All of this while dealing with the psychosocial aspects of critically ill patients and very concerned families. My deepest respect goes out to you guys who do a lot with a little. Hats off to you!

Thanks RRT! You've inspired me to tall with one of our RTs this week to better understand the workings of our Bipaps amd the settings. I only mentioned the 'back up rate' because that's what our most recent attending was referring to when discussing our attempts to wean a chronic vent dependant trach patient.