For all you PACU nurses please give me your input on this situation. Should patients be recovered in an ICU by nurses who have never been oriented to PACU nursing. A battle is being waged at my place of work as my colleagues and I refuse to recover patients in the ICU as we have no training in PACU nursing. Last week a patient was brought to the ICU intubated, unrecovered, with a systolic of 217. The ICU nurse refused to take report, and before you knew what was happening all the big chiefs were on the floor, and the argument ensued. Come to find out, our boss agreed to this new policy with the head of anesthesia, without notifying the ICU staff. The only problem they are having is that we refuse to take these patients, owing to the fact that patient safety is compromised, as we are not PACU nurses. Our ICU is not an open plan. Every patient has their own room, and the unit is massive. Our ratio is 2:1, and sometimes 3:1. We would not be able to stay in the room continuously with the unrecovered patient. What are your feelings on this issue. I have printed the standards of care for PACU nursing which I obtained from the ASPAN website for my boss. I will be giving this to him in the morning.
You have stated my point. We have no objections if we are allowed to go to PACU for one or two shifts to get a feel for what PACU nurses do. Maybe it is the same as what we do but we do not know that. In terms of the PACU nurse being with the pt by herself, well that is not what we are advocating. What we are saying is bring the pt to ICU with a PACU nurse, and an ICU nurse will assist. However the situation became a mute point yesterday as the issue went to the vice president, who agreed that a PACU nurse must come to ICU to recover the pt because of the dynamics of the ICU, and that the ICU must assist. The issue is about the dynamics of our ICU. We have a 20 bed ICU where every pt has their own room. The unit is huge and covers a lot of area. It is not possible to remain in the room with an unrecovered pt continuously, and to maintain some of the standards set by ASPAN such as a vented unrecovered pt needing 2:1. If you dispute what it is I am saying, go to ASPAN website and look at the standards of care. I am not naive to believe that all hospitals maintain those standards, but it is worth aiming for owing to pt safety, and not because of extra work for the ICU nurses. It is also worth mentioning that we have a PACU nurse who is on call for forty hours a week, who gets a full salary regardless of what hours she works. We only do emergency surgeries during the night, so there is not that many surgeries during the night. This also influenced the vice presidents decision.
I understand what you mean. Our experience however has been to be treated terribly by ICU. They don't help us and they expect us to stay far past the "recovery" period. Some pts just won't get more stable...that's why the ICU bed. I do believe the ASPAN citation, have read it, and follow it as much as possible(too bad the hospital does not). Certain pts are 1:1 and if no ICU nurse able to, then you need PACU. Why don't facilities cross train? I see so many RN's in ICU who are freaked out because the were floated from tele or ER. This is NOT the same type of nursing! I myself would refuse to float to ICU without training....so you are correct in trying to "refuse" recovering, until properly trained.
I understand what you mean. Our experience however has been to be treated terribly by ICU. They don't help us and they expect us to stay far past the "recovery" period. Some pts just won't get more stable...that's why the ICU bed. I do believe the ASPAN citation, have read it, and follow it as much as possible(too bad the hospital does not). Certain pts are 1:1 and if no ICU nurse able to, then you need PACU. Why don't facilities cross train? I see so many RN's in ICU who are freaked out because the were floated from tele or ER. This is NOT the same type of nursing! I myself would refuse to float to ICU without training....so you are correct in trying to "refuse" recovering, until properly trained.
London88
301 Posts
Sharran,
You have stated my point. We have no objections if we are allowed to go to PACU for one or two shifts to get a feel for what PACU nurses do. Maybe it is the same as what we do but we do not know that. In terms of the PACU nurse being with the pt by herself, well that is not what we are advocating. What we are saying is bring the pt to ICU with a PACU nurse, and an ICU nurse will assist. However the situation became a mute point yesterday as the issue went to the vice president, who agreed that a PACU nurse must come to ICU to recover the pt because of the dynamics of the ICU, and that the ICU must assist. The issue is about the dynamics of our ICU. We have a 20 bed ICU where every pt has their own room. The unit is huge and covers a lot of area. It is not possible to remain in the room with an unrecovered pt continuously, and to maintain some of the standards set by ASPAN such as a vented unrecovered pt needing 2:1. If you dispute what it is I am saying, go to ASPAN website and look at the standards of care. I am not naive to believe that all hospitals maintain those standards, but it is worth aiming for owing to pt safety, and not because of extra work for the ICU nurses. It is also worth mentioning that we have a PACU nurse who is on call for forty hours a week, who gets a full salary regardless of what hours she works. We only do emergency surgeries during the night, so there is not that many surgeries during the night. This also influenced the vice presidents decision.