TamaraRN

We use an very large cooling blanket machine that is older than I am, but it still gets the job done. It connects to a rectal temp probe. Our policy is to always use auto mode (never manual) & set the temp 2-3 degrees below core temp, & adjust as it comes down to avoid thermal injury. We put the blanket under the pt w/ a sheet between. I'll pass on the mineral oil idea. Thanks.

I work in a very similar enviroment to what you described. A nurse who moved here recently says "the staff & physicians here have had a dysfunctional relationship for so long that is now accepted, normal behavior." I found a conflict resolution class very helpful, I did not know that the hospital has a policy of no tolerance for bevavior that violates their "Code of Conduct." Even when I have not been able to reslove the conflict in the moment, I have used the lines of communication estabilshed in the policy with success. Your institution may have a similar policy. Good luck to us all!

As I'm also in California, any pt in an ICU bed gets the ICU nurse patient ratio. I'm working on getting approval for licensing several beds to flex into an intermediate level of care when needed. That would be 3 or 4:1, q shift assessments, q 4hr vitals. Right now I'm facing huge resistance, but I'll keep trying. That worked very well on the unit I worked in Oregon.

So this 20 year old kid goes over to another trailer in the park, barges into the kitchen where a kid is chopping up chicken, gets in his face, & says "So, I hear you're gonna kick my ass." One stab with a dirty chicken knife can be very effective when it's through the iliac artery! His mother had more tattoos than he did, & we had to set separate visiting times for his 2 pregnant girlfriends. The boy was a jewel when we extubated him, first time I've ever used a Haldol gtt. Another odd one... I took care of a lady after her 18 hour surgery to reattach her scalp (I advise against waist length hair around industrial fans). Her family wanted to take pictures to show her later because they thought the leaches were so interesting.

As a new grad in CCU I learned 2 things very quickly. There are a lot of right ways to be a nurse. And it takes more than 2 hands and 1 brain to care for critically ill paitients. Hang in there. Ask all the questions you need. Find out who the nurse geeks are on your unit, we love to teach!

ICU nurses have to be very detail oriented & they are often dealing with crises. We often need meds, labs, etc very quickly & don't have time to say please or thank you until the crisis is over. Unit clerks & people we work with daily understand this. Most of us are polite, most of the time!

With 5 years in ICU I've dealt with the withdrawal of care many times. It can be a really awesome & humbling experience. Medication wise, the best tip I can pass on is to place 2 Scopolamine patches on the pt when you extubate in addition to the MS gtt. It's a drug used for motion sickness & a side effect is to dry up respiratory secretions. This is an incredible courtesy to the patient & the family. It saves the patient the extreme discomfort of NT suctioning when they become unable to handle their secretions. It also saves the family the discomfort of hearing that "death rattle". As far as monitors, I find that families often stare at the rhythm & the numbers rather than looking at their loved one & interacting with each other. I like to turn the brightness all the way down on the monitor in the room so that the screen is black, but I can still see it at the desk, & the alarms are on to alert staff of changes. If I'm unable to remain in the room because I have another patient to care for, I find the family is reassured by my paying attention & knowing when something happens. Emotionally, anything the family needs goes. I try very hard to allow large groups of visitors, bring in chairs, put several boxes of Kleenex around the room, bring in water, & find out if any of the visitors is diabetic or has any special needs that we can help with. I always encourage the family to bring in their spiritual advisor, or offer our chaplain or a priest. Gently feeling out the issue will tell you what are the spiritual needs without pressing. Preparing the family for what will come... Tough subject. The doctor will probably tell the family, & you can reinforce, that there is no way to predict how long it will take. It could be minutes or days. Obviously, we can't keep a unit bed occupied for comfort care for very long. Many hospitals have a beautiful oncology unit, where the patient & family can wait in comfort. The oncology nurses have a great deal more experience with comfort care. It's really great to prepare the family by telling them that if their loved one makes it until morning (or whatever cutoff is appropriate) they can anticipate transfer out of the unit. It's also a good time to let the house supervisor know that you may be requesting a private room for transfer in the morning. Withdrawal of care is an opportunity to make more of a difference in peoples lives than many of the heroic & exciting things that we do. I've cried & prayed with many families. It's a chance to connect with people and be a part of one of the most important and memorable things that will happen in their entire lives.

I'm working on a project to convince a very budget conscious administration that it would be advantageous to bring CNAs/Critical Care Techs/Patient Care Techs or whatever name for Unlicensed Assistive Personnel into the Unit. I'd like to find out how techs are used in units across the country. What is their scope? How are they assigned? Tech to patient ratio (day & NOC)? And anything else you think might help. Thanks so much

Kathy White! Also available in PDA format.

Kathy White! Also available in PDA format.