RN student needs input

Charles S. Smith, RN, MS · Jan 31, 2001

Originally posted by janine3&5:
Have to do a research project for ICU rotation--nothing in-depth, just a brief presentation on an everyday concern or problem ICU nurses face. Can be issues that negatively affect patient care or ideas about techniques or protocols that would improve patient care or patient satisfaction. Any ideas?

Many of us on these boards could give you tons of fodder for a presentation. However, maybe you want to make your presentation not merely a course requirement, but something of value to the critical care RNs in your hospital. Talk with them directly. They can give you the best feedback for a reality based issue in your area. Also, maybe offer to tackle a real life issue and present back to them. It is never too early to begin building your confidence in presenting and your curriculum vitae....

regards

chas

janine3&5 · Jan 31, 2001

Thanks for the response--I do plan on talking to the nurses in my hospital. However, would like a general idea of where to begin. I can see that the nurses don't have a lot of spare time to talk while at work, so I thought if I knew what direction I wanted to take first...This is to be a brief synopsis of research already done; along with area nurses' response. There are just so many research journals out there that I want to narrow the topics to something a LOT of nurses question or struggle with in the unit.

janine3&5 · Jan 31, 2001

Thanks, ratchit! I think I can find a good starting point in one of your thoughts--transfering of ICU beds--I know that's a big problem in our hospital. Thanks again for the brainstorm!

ratchit · Feb 1, 2001

Big item these days has been staffing. ICU patients are sicker and the interventions are trickier by the day. But the ratios are creeping up- some places are now using 1:3 as a standard, not an exception in crisis. More to do for more patients- the well isn't bottomless. And with the shortage worsening, it isn't likely to get better.

I bet every nurse you work with could give you stories about the OT, the effect on their personal lives of the added work and stress, etc. Not to mention the effect the reduced nursing care per patient has on outcomes.

Recent study (can't remember who did it) found one extra hour of nursing care per patient per day reduced nosocomial infections and hospital stays. ARticle in the Washington Post about 10 days ago quoted a neurosurgeon who suggested his patients hire a private duty RN when they were on the general floors because nursing care affects outcomes and the floor nurses are overwhelmed by their patient loads.

CA has been legislating patient ratios in some areas- these could all be sources for you.

Another twist could be inappropriate use of ICU beds. Seems like very often there are a couple patients in the ICUs that don't need to be there but the docs won't transfer them because the floors are too overworked to watch them. The floor nurses have too many patients to provide the care the floor is meant to give so the patient ends up in ICU longer- exposed to more bugs, deprived of more sleep. So since the ICU is short too, that patient becomes an ICU nurses third patient "they don't need much anyway."

But if there is a code or a trauma, the ICU nurse with 2 critical and one stable pt ends up having to fight for transfer orders on the stable one, then pick up a third critical patient. And a floor nurse with 9 suddenly has to pick up a 10th in the middle of a shift. The overwhelmed floors led to the inappropriate use of the ICU bed which led to worse staffing in both the floor and the unit. And this affected the care all the patients received. Happens at least one of my 3 12's a week.

But if the floors were adequately staffed at least part of the chain of problems could have been avoided.

So there's a couple ideas of hit items bugging ICU nurses lately.