Recovery of OR patients in CCU

wildwood · Dec 6, 2003

Hi, Cliff,

I know what you mean about the new people not having a clue about the nightmare of 10 days of call! Hopefully, they never will.

When I first started in the OR (about 16 years ago), we only had 4 nurses taking call. I got 3 months orientation, and was thrown into call - called sink or swim!

At our rural hospital, we do a tremendous amount of callbacks, many of them true emergencies - gunshots, stabbings, aortic aneurysms - you'd be surprised. CRNA's who come from trauma centers to work with us (they help fill in because we are short of CRNA's) are amazed at the number of hours we work on call.

But unless, God forbid, the staffing gets worse and these people actually experience it, they'll never know the stress and exhaustion you endured.

One thing I have observed in my years working in the OR, many of the new younger people coming in simply won't tolerate this kind of work. I guess when they see how the workload is, they know they can go somewhere else. Even though we have 5 call teams now, we still work hard. We have call for all specialties, so if you're not working with one surgeon, there is always another needed to do a case!

I have been at this same hospital 21 years, and could not start out making anywhere near the salary I have here, and benefits. So I sometimes feel trapped, being on my own, with a house payment and car payment, etc. I have RA, Fibromyalgia, hypertension, asthma, and now, pericarditis from the RA. SO WHO WOULD INSURE ME?

Sorry I know that last part doesn't really belong in this post, I just ramble on sometimes. When you are older, you tend to do that!

But to my credit, I can still work circles around some of the younger nurses (experience pays off). You really appreciate the ability to prioritize and plan when you are in pain and need to get your patients cared for!

ckalston · Dec 8, 2003

I hear you Janet. It is hard to understand where one is coming from unless we walk in their shoes. We also cover all surgeons that are on call, so regardless of when your on call, someone will be doing surgery. We also have to cover for simple things such as endoscopy, so even for short cases we go in. I also know where your coming from about pay issues. I am in the same situation (almost) as you. I have worked at this hospital for 8 years, make more here then I could get starting somewhere else. My insurance covers my heart condition and other ailments including my family, and if I were to change, I would have no coverage. Sometimes I think a job gets you where they want you and know you really have no choice but to do what they say.

kyti · Dec 8, 2003

I have worked ICU for 5 years prior to working in PACU so I can see both sides. I agree non-vented pts should be recovered by a PACU nurse. But , vented, sedated pts who are going to remaine vented and sedated do not benifit from coming to PACU. After hours on call I am the only nurse in the PACU ( with maybe a secretary or aide) the anethesiologist goes home. If a patient bypasses the PACU it is not my decision. That is up to the anesthesiologist, and he or she needs to stay with that pt. until they are stable. Sorry, this is a very sensitive subject to me. Remember, not our decision if a pt bypasses PACU it is the anesthesiologists choice.

ckalston · Dec 8, 2003

I agree with you kyti. Very good point.

pghfoxfan · Dec 9, 2003

When I worked in CVICU, we also reacted patients on off shifts...it SUCKED!

jenny867-5309 · Dec 9, 2003

ICU recovers a lot of pt's in the facility that I work for. Of coorifice there are standards for transport and such. The pt must be accompanied by an RN with monitor, code meds O2, etc. The RN transporting is then responsible for the pt's care until pt is endorsed to ICU RN.

It is not a violation of any law to recover OR pt's in ICU. The level of care must be able to be maintained.

zrmorgan · Dec 9, 2003

how do you recover a patient who is to remain sedated and vented?

just food for thought...

z:chuckle

sharann, BSN, RN · Dec 9, 2003

Originally posted by zrmorgan
how do you recover a patient who is to remain sedated and vented?

just food for thought...

z:chuckle

Exactly! Kyti also hit that nail on the head.

If the patient is vented and on sedation/paralytics, and are expected to stay that way for more time than normal recovery...what do we in PACU need to do for them? If the patient is not stable enough to transfer right away (i.e AAA or thoracotomy), if BP meds need titration etc..or anesthesia wants us to recover its another thing. The patient WILL go to ICU in these cases. I am against ICU recovering regular cases because they lack the training (I take care of ICU patients, very critical patients all the time, but I am not ICU qualified...would never float there).

It's interestin that this occurs so frequently, not just us.

kyti · Dec 9, 2003

exactly my point. pts come to recovery so we can monitor and protect their airway and stabalize their vital signs until they are awake. vented sedated pts have a patent airway thanks to vent and are not going to wake up and may not have stable vital signs. This is not an anesthesia problem it is a critical illness issue,and critical care pts belong in ICU. If they are that criticaly ill one hour in PACU is not going to cure them. They will still require 1:1 or 2:1 nursing care when they arrive. sorry about the typo's it is very late and I had a very long day.

jewelcutt · Dec 11, 2003

I am having a hard time understanding what people are complaining about. I work in an SICU that recovers all their own open hearts and believe this is the way it should be. We also take other SICU cases, including AAAs, thoracotomies, open bellies, occasional traumas, nephrectomies, etc. because we are the only unit in the hospital that can take any type of patient. There is another SICU in our hospital that is mainly neuro/trauma/general and they absolutely refuse to take direct admits from the OR except traumas. This is absolutely ridiculous! If you are an ICU nurse you should really have no problem recovering any type of patient. Our SICU and PACU get along very well because we respect each other. We often take direct admits of patients other than hearts because if we have the bed open and they are categorized as needing ICU care that's where they should be.

As far as taking general PACU overflow that won't need ICU care I don't agree with this. These patients are not your responsibility, I also imagine there would be a high turnover rate with these patients also.

Personally, I like admitting directly from the OR because I recieve face to face report from the CRNA and MDA. I have gotten to know them pretty well. I would think that anyone wanting to go to anesthesia school would jump at this opportunity. And actually, when applying to anesthesia school at my hospital these CRNAs are asked about how we present ourselves on the unit.

New CCU RN · Dec 11, 2003

Originally posted by jewelcutt
I am having a hard time understanding what people are complaining about. I work in an SICU that recovers all their own open hearts and believe this is the way it should be. We also take other SICU cases, including AAAs, thoracotomies, open bellies, occasional traumas, nephrectomies, etc. because we are the only unit in the hospital that can take any type of patient. There is another SICU in our hospital that is mainly neuro/trauma/general and they absolutely refuse to take direct admits from the OR except traumas. This is absolutely ridiculous! If you are an ICU nurse you should really have no problem recovering any type of patient. Our SICU and PACU get along very well because we respect each other. We often take direct admits of patients other than hearts because if we have the bed open and they are categorized as needing ICU care that's where they should be.
As far as taking general PACU overflow that won't need ICU care I don't agree with this. These patients are not your responsibility, I also imagine there would be a high turnover rate with these patients also.
Personally, I like admitting directly from the OR because I recieve face to face report from the CRNA and MDA. I have gotten to know them pretty well. I would think that anyone wanting to go to anesthesia school would jump at this opportunity. And actually, when applying to anesthesia school at my hospital these CRNAs are asked about how we present ourselves on the unit.

I don't disagree with your post. However, often times it has nothing to do with the actual nursing staff and more to do with the policies of the unit. For instance, my unit does not recover...period. We along with the two other medical ICU's have this policy which was decided upon by the medical director of the hospital that medical icu's do not recover. While I don't disagree that ICU nurses should be able to, I cannot disobey policy due to my opinion. It does create a hassel, I agree... and the PACU isn't going to solve the patient's underlying issues, I don't think anyone expects that. And I would love to recover the patients considering I want to become a CRNA.. and am possibly transfering to a surgical ICU. This topic has been debated numerous times at my facility (a large teaching facility, 800 plus beds with 7 adult ICU's), but again and again the higher ups say no recovery in medical units...

mommyof2grls · Dec 12, 2003

I got my start in a level 1 Burn Center with it's own OR. We recovered all of our own patients. We had our own OR for a time, then even after we stopped using it we still recovered all of our patients. Mostly becuase some people just are not sure what to do with a Burn. I tell people in class that it is just a big multisystem trauma. Take a breath, and think.

When I worked PACU the nurses would have a fit if they had to recover a burn, even if it was a simple debridement. I think some of the bellyaching my have to do with not being familiar with some types of patients. You get out of your rhythm so to speak.

Yes ICU nurses are not normally expected to "recover" a patient, but they can. Should they be asked to? Yes and no. I think in the extreme situations it is acceptable, but I think it is lacking in continuity of care when they are asked to do this on top of other assignments. I was asked many times to recover a patient because I had a light load or an empty bed. The problem with this was the whole picture was not seen. I'm in charge, Green newbies, 12 outpatients and 3 of 4 nurses on 1:1 patients with an additional patient to boot. I was the one who was bullheaded and told anethesia no way. I never asked anyone to do anything I would not do. I felt that the higher ups did not see that this was severly risking the patients safety as well as my license.

Over all, if staffing is there I say we help one another all we can. But don't get mad when I say no, because there is usually a pretty darn good reason or 2 or 3.

My thoughts....

Oh and I am one of the nurses you may see sitting in my cubby.watching the patient or chatting. Just because I have a seat, does not mean I don't have a heavy load. I am the type of nurse who gets her sh** done, takes a breather, then heads down the hall to help co workers, then back to mine. You never know when that pager is going to go off, when another unit will call for help etc etc.

If I don't have a seat, I've got a pat. circling the drain. Ot Trauma's out the ying yang. I believe you can be busy without looking like your running around like a chicken with your head cut off. The best nurses I know are the ones who when you walk in the unit you would think they didn't have a thing to do. Those were the ones I wanted there when I was in charge. Things just ran alot smoother.

Just my opinion