KymmD77

We have 2 units which all staff float between. The main ICU with 10 beds and a "step-down" with 8 beds. We normally have 2 pts per nurse. And a secretary. No Techs, no CNAs and our managers do not do any pt care. When the census drops, to say 6 pts in the main ICU, we loose our secretary. This is a locked unit, we have to open the doors for visitors and phones ring off the hook. All order entry is done manually and doctors are constantly asking us to print them stuff. The staffing is based on whether the pts are "ICU" status or not. We can have 2 really sick pts, or 2 stable pts and it's just the same to them. It doesn't have much to do with acuity. The other day we started with 4 pts between myself and another RN. Between noon and 8 pm we transferred out 2 and received 5 adms!!! And we never qualified for a secretary, because we never got to 8. I was charge and both my pts transferred out at the same time we were getting adms. I couldn't help! It was so crazy. Nobody was able to put in orders or make charts. The paperwork was piling up. Sick pts: a post code, and Trauma One, a confused and drunk CVA, an AMI who was pulling everything off. But we never qualified for more help. We called in one nurse, who had to take 2 adms and had another nurse who was going back and forth between our unit and the ER where she was working as "helping hands". If I have my 2 pts and am charge, and the other two nurses have 2 a piece, who is supposed to be doing the secretary's work?? I guess I'm just wondering if it's like this everywhere? And do you have any suggestions about how to deal with this? (It has been going on for years...)

I have a few: First was a guy who was being taken care of by a nurse who was new to the ICU. The doc had come in to perform a thoracentesis and drained an impressive amount of fluid. Shortly after this, the nurse decides to put the pt in the cardiac chair. Stood him up, the pt went orthostatic, and once they got him into the chair, was way Brady. Unresponsive. We ended up coding him, in the chair, but he didn't make it. We also had a 17 yo that came into the ER as a Trauma 1 that I responded to. He'd fallen off a 3 story roof, is head was split. Everytime we'd do a compression, blood and brain matter would spurt out of his head with each push. He didn't make it. I also had an MI who was young, in his 50's, and had 2 daughters in their mid 20s. He was inoperable. The docs said they try their best medical management, but jad given less than 6 months. The next night, after being fine all day, he suddenly did the classic AMI in the bed right in front of me. Pale, diaphoretic, cp, sob. But he had the capacity to tell us not to do anything. His daughters agreed. And he passed within 5 mins. 10 mins before this he was eating his dinner, laughing with his family. And I also had CABG who was high risk, came back to the unit 3 hrs late, open chest, balloon pump. Dumping as fast as we could squeeze the PRBCs in. Looking at her numbers and the bleeding and based on the OR personnel, the Doc had obviously nicked the PA! Yes, I've seen that a few times, and it is the stuff that would put the horror movies to shame.

So I'm scheduled to take my CSC in a month. Just to give you some background: I've been working in a mixed ICU for 5 years, I've been recovering hearts for 4 years, and I recently renewed my CCRN after my 3 years were up. I do not primarily recover hearts. But I do get a rush of them here and there and avg 3-5 per month on a good month. I'd say I've done at least 100. Some very complicated, some not so much. My worry is that we are old school. Still use swans. Pts come back intubated. CTs, PWs, the usual drips: Milrinone, NTG, Nipride, Dopamine, sedation, possibly cardizem, insulin gtts. I've seen everything from a cruise on out of the unit to a crash and burn on arrival. MVRs, AVRs, CABG, CABG redo's, windows ...all with or without IABPs. So what do I do to study??? What content does the exam focus on? Any advice from anyone who has taken the exam would be much appreciated!!!

Curious, what is a CC assessment? Critical care? Or is it something new? I forgot to mention our Meditech version is the old DOS from 1996. I know there are newer versions available, which I hear from travelers and agency are much more user friendly. I'm wondering if you guys are stuck in the dark ages as well? Or are you using a newer Meditech?

Thanks Again!

Thank you for the article! I need articles like this and I'm also looking for policies from other facilities.

Thanks for the response. We used to do Q4, but at that time we had F5. When they took it away we switched to Q6. So I'm just curious if you can F5 your 2nd and 3rd assessments?

I have a question regarding ICU documentation for HCA nurses and/or Meditech users: How often and how are you documenting your pt assessments? Full head to toe "shift" assessments as well as "focus" assessments? We have always done Q6 "Shift" assessments, and added in any additional focus or task list issues along with narrative notes as needed. Now, we are being asked to do a "Shift Assessment" at the beginning of the shift and Q2 "focus" assessments regardless of whether there is a change. (Oh, and we don't have the F5 function available.) So I'm wondering if this sounds like what other ICU's are doing and if this sounds right? I've been trying to find any "standard" regarding frequency of assessments (on the BNE site, we're in Texas, AACN, AJCC, Google, anything) and I can't find anything and our facility doesn't have a policy for ICU documentation. Any help?