CVRNof4

First off it was not my pt.-I was in charge of the unit and had other nurses to help out...Believe it or not the pt. was not symptomatic (bilateral amps to the groin, ESRD, spends most of the time in the hospital...). As RNs I do not remember learning or being licensed to hang pressors without an order. The eICU MDs can only give orders on certain pt.s in our CVICU-they are catergorized. This was not a category III pt. where they could freely give orders. They went above and beyond when I called them-not the RN at the bedside. The so called intensivist who did not answer his pages was fine with the orders. Later that night he did not return a call on a pt. that was admitted for over three hours. You can have your opinion, but obviously the Magnet hospital I work at finds a need for it...and yes we are one of the number one heart centers in the Midwest, unfortunately some of the overflow pt's we receive have to have incompetent intensivist (and not the eICU MDs-they are only allowed to do so much in the unit I work in). Best of luck to you in your nursing career.

Here is another example of how the eICU has worked. Last night while I was in charge a pt. was admitted-SBP 55. The Intensivist that was consulted did not call back after one hour of numerous pages and calls to his home. Called the eICU and received orders for volume and pressors as needed. As RNs we cannot just start a drip...and I really am offended by Diniths post-definately not one open for change. What if you go to computerized charting like we did a few years ago...what negative things will he/she have to say about that, or getting rid of NAs, or pt. to RN ratio changes for productivity? Come on-until you have used it you cannot have anything to say

Here is a great example of how the eICU helped a patient the other night...The pt. had extensive cancer of the mouth, neck and a total resection of his mandible. The pt. went into a respiratory arrest. The code team of all qualified personel responded; however they could not intubate this pt. orally or nasally. The eICU intensivist gave suggestions to the respiratory therapist and bedside intensivist and guess what...after a 1/2 hour of those at the bedside attempting to intubate (luckily they were able to bag the pt. enough to maintain a good sat) they were able to with the suggestions of the eICU doc. Pt. is doing fine. Many of the small rural hospitals that our eICU is affiliated with have new grads or not as experienced nurses. Often times they will utilize the eICU. I agree with the above post-if you believe that you do not need it-don't use it. I have worked in a CVICU for many years and believe I can care for my pt. or two without any help, but when you are put in a situation where both pt.'s are crashing-believe me the help of the eICU is invaluable to me. This is including heart, lung transplants and VADs. The surgeons where I work have even used the eICU at night to manage a pt. when appropriate. As nurses we do have to be open to change and technology. When our hospital went to computerized charting (Emtek-not Cerner) we all were resistant. Now I would never do it any other way.

An ICU pt. is monitored by RNs and an intensivist outside of the hospital at a remote location. Trends are watched on monitors (HR, hemodynamics, labs etc..). There are also cameras in all the ICU rooms with a speaker so if something happens the nurse or doctor can ring into the room and talk to the bedside nurse. Patients are only viewed when necessary. The camera is not on at all times. Very interesting concept and research has shown that it decreases the mortality rate in the ICU. Trends can be monitored closely and interventions made before an incident occurs.

Does anyone work in one of these new parts of the ICU care? Was wondering...looking for opinions of this. Thanks

I have worked in both settings over my 18 years of nursing. Both have their benefits, but with the cost of gas and your health the community hospital is a much better choice. You may not get all the experiences you would in a teaching hospital; however there are other benefits. The smaller community hospitals seem to really care for their employees and you will see the longevity of the nursing staff. You may also get great support in your early career as a nurse. Good luck and take care of yourself first!!

I could'nt agree with you more! It is not about the good care that a patient receives-it is about how the family perception of THEIR interaction with the nurse was. Recently had a family member enter another pt. room (what about HIPAA???) because their family member needed to go back to bed (after only being in the chair for 10 minutes). Because my reply was that the pt. had to wait and that I was caring for another pt. (much more critical also) the family member filed a complaint. I have also seen an excellent nurse quit because a family wanted a formal apology from her because she was in a code of another pt. and did not leave to answer a question for them (their family member had been in the unit for over 30 days). And...what about infection control? We have babies, toddlers playing on the floors in room and family members walking around in their socks...little do they realize the risk they are putting themselves in...and if you say something you are considered not promoting good customer satisfaction!!! Makes me so angry. I am glad that I will be soon leaving the bedside for another nursing postion that does not require direct pt. or family involvement.

Our family members can camp out in the room-luggage and all!!!

When I first started in a CVICU 14 years ago we had very strict visitation-3 15 minute visits per day. The exception was made for long term patients or those dying. NOW we have an open door policy-anyone and everyone can enter-it is a disaster. Surgeons are opening a chest at the bedside and family members are walking past-unreal situation; however someone decided this was good for the patient. What about the nurses?? We can no longer do our work because we need to be pleasing family members-getting them water, coffee or a pillow. If you do not you are reported for being a "difficult" care giver. Does the patient really want their family member to watch while they are getting foley care?? Or if they are paralyzed and sedated who is really benefiting from the visit?? I say lets go back to the old days with visiting hours and restrictions for children entering the ICU!