ICUNurseG

I work in a ~400 bed hospital. We are based in critical care and help out throughout the ICUs only. We help with anything from admissions to crashing pts to turns. Lately due to budget we have to be monitor tech on one end of the unit. So we aren't able to help the other ICUs unless they're desperate and we do more tech work when we're not at rrts.

Happy anyone made the transition from adult ICU to NICU? I have worked adult MICU x5 years and am possibly looking for a new position. Mainly due to poor management issues but also burnout. I'm aware that there are still going to be ethical dilemmas, moral distress, & burnout in the NICU (there's a reason my hospitals neonatologist is chair of the ethics committee). Where I work has a Level 3 NICU. What should I expect there?

Disease processes & their to such as septic shock, MI, COPD, etc. it wouldn't hurt to review ACLS also, even though you'll have to go through the class before you can officially use it. Hypothermia after cardiac arrest is another good one to study. When you get one, even in orientation, you'll be too busy to learn details. Know why you do it and indications/contraindications. Everything else should be in your hospitals policy or protocols.

I work in MICU and currently we have an out of staffing role to respond to code blues & RRTs throughout the hospital. When not attending an emergency this RN helps out around the critical care units with anything from turns to assisting with procedures. The problem with this role is that its not well defined. We only have one of staffing allows (if not someone w pts responds) and often this person is pulled into staffing for new admits. We are going to revamp the role and I'm looking for suggestions. Does anyone currently do this and not get pulled into staffing? The problem is there could be RNs with three ICU pts and the emergency RN responder out of staffing. Of course, they would first help those with three pts, but I'm not sure how it would work out. Also, do you guys have emergency RN responders that do other roles too? Like debriefing afterwards, being a resource, etc. any input is appreciated. Thanks!

I work micu, so I'm biased, but I think you should take that. Medical pts are very complex and you'll learn a lot about disease processes (sepsis!!) and managing them. You'll have ACLS down as well.

We check them on all gastric feeding tubes q4h. Anything 300ml and under is replaced. It can screw up ph and electrolytes if not. Think of it as if they vomited that much and how that would affect them.

"I produced some upchuck." I didn't see any vomit anywhere and the patient looked fine. I asked where he threw up and he said "in my mouth. I thought you might need to write it down." I'm pretty sure it was reflux. [emoji37]

Yes, we do with integrilin. Not heparin, but they shouldn't need a heparin gtt after a stent is placed. We pull if the act is

Gambro prismaflex here too. They're user friendly and the reps I've met are very knowledgable about the machine and crrt therapy. They teach the training and refresher courses for us. I've met and taken training from other product reps and they are not always that knowledgable about their product as far as real world use.

This sounds great, but I have to agree with the point that patient flow wouldn't allow for zoning to be optimal. I work in a 24 bed MICU and we have certain rooms with dialysis and one room for remote fetal monitoring. As much as we try to leave those rooms available for what they're made for, it doesn't always happen. For example, if the RN open for admission is in an area where the only room available is a dialysis room, that's where the patient goes, regardless or whether or not the pt is on dialysis.

Where I work the flight RNs are employed by the hospital. They work 12 h shifts and when they're not flying, they're helping in the ED, doing case studies in ICU, etc. they do a lot of transports, since we are a level 2 trauma center surrounded by many rural areas. They often have to pick up pts from other hospitals that aren't capable of caring for critical patients many of them can't care for intubated pts or even have a cath lab, so they keep Our flight crew busy.

I took it when I had been an ICU nurse for a year. I thought it was a great class and I'm actually looking forward to renewing next year (nerd alert). I don't know if all classes are different, but i remember the stations weren't all skills. There was one for intubation but the others were vent and bipap management and I'm sure some others I'm missing. The first day of class was mostly pulmonary/vent management. The second day was the other systems. It was great to learn from the experts (physicians) who taught.

Yes. Our hospital has a protocol that when someone is started on TF we do accuchecks q6h x 24h. If they're normal, we stop them. Remember, even if they're not diabetic they are probably at risk for hyperglycemia of critical illness. Most pts we start TF on are usually on a vent, etc. In my opinion, fingersticks are safe and easy; unnoticed and untreated hyperglycemia is not.

The last time we got any safe lifting training was two years ago when our facility purchased "slipper sheets". These are used to transfer pts from bed to bed and pull the pt up in the bed. It's a glorified garbage bag. They work really well transferring from bed to bed when we receive a pt from ED or another department. They want us to use them to pull pts up in the bed. I have never seen this outside of training. In order to do this, we would have to roll the pt side to side to get the slipper sheet under them, pull them up in the bed, and remove the slipper sheet. Supposedly it can be removed without turning the pt. I work in ICU where RNs perform total care (usually don't have a tech) and most pts require turning q2h. I have told my boss over and over that it is more work to roll a pt side to side to get the sheet under them Than it is to just pull them up. Of course, the hospital now will not pay for employee injuries if we weren't using a slipper sheet

Drips: -vasopressors: levophed, vasopressin, epinephrine, dopamine, phenylephrine -antihypertensives/vasodilators: nicardipine, nitroprusside, nitroglycerin, labetalol -positive inotrope: dobutamine, isuprel -sedatives: propofol, precedex, midazolam -analgesics: fentanyl -misc: heparin, insulin -paralytics: vecuronium, norcuronium Intubation meds: -etomidate, midazolam, succinylcholine ACLS meds *know your hospital's policies on these drugs and their titration parameters. Also know which drugs you keep on the unit and which ones pharmacy sends. Most emergency drips (levophed) can be mixed on the unit.