CCPam

Hi Everyone, I'd like to bounce this one off of you all and see what your suggestions are. Since June 06 we have "inherited" a 4 bed mini "icu" that is a satellite from our 9 bed unit Neuro icu. There were several issues brought up to the administration before we moved in and the list of concerns keep growing! Here's just a few of the concerns. We are budgeted to staff with one icu tech, who also doubles as the clerk...their role is complicated by the work of 2 jobs and only 2 other RN's to help. I can't imagine how they (the techs) cab do either job well, especially in a code situation! The unit is a good 100 yards around the corner and down the hall. If an emergency comes up then the charge nurse is responsible to come down and help (no assignment). It is customary to move the sicker patients to the main unit (unneccessary moving of patients and utilization of housekeeping to clean those rooms) for improved monitoring and support from ancillary staff. Often we don't have even emesis basis for patients with post of nausea and vomiting. I was told there wasn't room for them! I responded...I bet housekeeping will love patient's barfing in the garbage can! Also, there is 1 bathroom to use as a hopper and for other ambulatory patient's to use. The unit is super small. Often patient's families cannot even stay in the room with a vent, CPAP or CCTV-so, they sit in the aisle--it literally only fits one person! The rooms are divided by curtains, no walls or doors and is extremely noisy just with normal conversation...imagine the patient going through delerium tremors screaming and call you every name in the book! Would it be a hippa violation as the patient next to you can hear doctors/team rounds reading vitals, discussing diagnosis, etc. Ok, I'm hoping you get the idea. What are your ideas about this? We have a "town hall meeting" in Jan. with the chairman of the neurosurgery department and I'd like to be ready for it! I'd like to see this unit be turned into more general care beds! Thanks again for your insights! CCPam

Thanks for asking....you should LOVE what you do!!! See if you can shadow in a Neuro icu for a couple of days....or get a summer externship....you'll either love it or hate it! But, you'll know before you hire in! CCPam

Wow! I've never heard of this Propofol syndrome either!! We use it a lot and I would like to learn more about it. Anyone with info in the form of an article would you please post it for all of us to benefit from,please? Thank you!

Hi Matt, Hey kiddo, don't be so hard on yourself! And, your preceptor shouldn't be either! The role transition between an LPN and an RN is a huge hurdle to clear---and, you've done that! Pat yourself on the back! Now going from one to two patients is another. Your preceptor is telling you to pick up the pace, but, is he/she offerring you any timesaving tips or organizational strategies? That IS part of a preceptor's job....to prepare you to be a good icu nurse in a real icu. Ask he/she for more specifics....if you are taking 30 minutes for mouth care on a vented patient...then they need to say that. Take a minute and reflect on what parts of patient care are easy for you and what you struggle with....usually, you are a bit slower in the areas you struggle with. Start with that. You are open to questions and constructive criticism and that is the first step towards getting help and doing better. Come back and keep us in touch......and don't give up!!!! That is the only way you will fail. Even the most experienced nurses have days/weekends/months of complex patients, wacky schedules and whatever else makes neuro the land of the nuts which really challenge them to be organized. Take care! CCPam

Oh man! Why I like neuro icu! Well, between the current 10 bed nicu I work in and the one in virginia---that adds up to 20 years of neuro. For some odd reason, the brain with all the invisible working parts, just fascinates me! I love our docs! they treat us with a lot of respect, give us a lot of autonomy and they pass that along to the interns every month---so, that really helps! The wacky neuro patients with their crazy answers to the orientation questions, watching the CCTV and doing conscious sedation with all the propofol, versed and stuff, just really is my thing. But, neuro is not for everyone.....and, take comfort in knowing that there is a nursing specialty that you will love...you were made to be there (if you have been true to yourself). I tried SICU for a couple years, only because there wasn't a nicu per se, I was good at it, but, it just wasn't where my nursing "home" was. If you are good at something and enjoy it, you are usually gifted for that job. So, be true to yourself, try visiting/shadowing several ICU's and stepdowns and monitor within yourself what you find fascinating, what you feel at peace at doing, and what you are good at.

try Babelfish....................it will do the trick. Also, ask family members who do speak English and Spanish to help you. I've learned a lot from them as well! Have you considered taking a college course in beginning spanish? CCPam

Joann Hickeys book of neurological and neurosurgical nursing is an awesome book. I think just about everything is in there! Good luck---and ask lots of questions! CCPam

Hi! The patient's neck should be stabilized in some manner (Miami J collar, traction with tongs, halo or surgically stabilized. To not turn a patient for even less than 24 hours can lead to decubitus, atelectasis, and all the other respiratory and circulatory problems that quadraplegics/paraplegics are so prone to. Talk to a Clinical nurse specialist or your PPM (professional practice committee) to develop a standard of care for these patients. Or, transfer them to a facility that has one in place that will reduce their morbidity & mortality.

Hi Hiliary! First of all I have to express some concern regarding the institutions placement of a patient with a severe SAH. I think it's quite unfair to expect someone who isn't very familiar with an aneurysm/AVM patient with an grade IV-V SAH to take care of them! It sounds like you did an awesome job and raised some good questions! I'm actually surprised that the coiling was done considering the absence of many of her basic reflexes. But, I have to ask this....our coilings are done under a general and I'm assuming that yours are too....was the exam done while the patient was still under the general? I'm guessing it was not, due to the result of the dolls eyes test. To answer the coiling question for Papaw John. Endovascualar coiling of cerebral aneurysms is something that has just been undertaken for the treatment of those unclippable cerebral aneurysm. It's an angio into the cerebral vessels where the radiologist/neurosurgeon floats coils (or some other object of choice) into the aneurysm. I'm at a loss as to how to answer your question regarding the apnea test being done initially with the patient on 30mcg (?) of Norepi and then bulking at the idea of doing it on 24mcg. Was the initial test ordered by a resident and then the senior resident or attending assessed the patient? The apnea test is done to determine the absence of the respiratory effort and confirm the diagnosis of brain death. Each institution is different in their numbers but at our institution if the pco2 rises to above 60 then it points towards a confirmation of brain death. Thank you. Pam