I'm a fish out of water in my new 'home' AND TRYING TO ADJUST...lol!
Rural LTAC who will be doing some surgeries(even pedi) and acute obs patients. No ER. No doc on premesis. BUT a 5 bed ICU where they want us to be able to 'do just about everything an ICU could handle including pedi' which I'm having some trouble with ...as no doc or CRNA around.....I'm NOT a pedi ICU nurse either which concerns me.
Asked my administrator the other day what my responsibility will be if a chest pain drives up. (even tho we do NOT have an ER perse it happens) Call EMS and do what you can til they get there was the answer, which is fine. But if they need intubation what then? He said "You have ACLS, right?" Well yah but I've never intubated and really don't WANT to......so how do others in this situation cope with this?? Guess I would bag and let RT deal with it til EMS arrive.....?
But inpatients will be expected to be managed in our 5 bed ICU and I'm concerned a bit about what I'm getting into and the liability associated...sounds like we will be expected to 'handle' a lot of stuff with no physician around ..how do other small facilities deal with this stuff????
Sorry I am rambling here...new experience for me and have been very spoiled up to now I guess...have always had an ER doc and anesthesia around to help....along with doctors hanging around to grab for that unexpected patient deterioration...
Anybody have any hints about questions I need to ask my DON and/or policies we should be writing to protect us?? I am having an uneasy feeling this stuff is not being addressed yet and I may be biting off more than I wish to chew....LOL!!! Maybe I'm wrong....
Would appreciate all input greatly...Thanks all!
Apr 28, '04
Thanks for responding guys!! I appreciate it! I've met with my RT's and most feel confident about intubating so that is 'one' less worry for me <whew>
I've approached my DON about soliciting a few $$ hungry medical residents to sleep in house at night...to cover us in the event of a major emergency. She is considering it...
I do worry about being held to medical standards in codes as have always relied on a doc to eventually take charge (even tho I will run things til they get there). Our docs do not come in if they can possibly get out of it...altho they must if they are not DNR's...to pronounce. All 5 of ours are ACLS codes ...
We have 5 vents (ETTs) now in our ICU (transfered from acute ICU's) and they are still fairly acute on drips with complications, etc. Sure would feel better about having a doc in house....
I have a major hospital 20 minutes away with ER, cath lab, MRI, etc...so I am having some ethical problem with why some of these patients are here when they are on life support and drips, etc...and the family wants everything done. Many are being unrealistic in their loved one's long term prognosis for recovery but I worry about liability.
I am guessing $$$ is the issue/reimbursement must be there for acute LTAC.
Have any of you approached docs and families, administrators to get a patient transferred to a bigger facility?? I am concerned I may get to that point and am trying to choose my words and think ahead of time where I will draw the line. I am thinking I will have to advocate for them ethically ...my biggest fear is what if a child goes bad postop and they want to place it in my ICU??? Would I be out of line insisting the recovery room nurse stay and care for that patient...as she at least is a pedi trained nurse with PALS? I'm thinking it will be that or transfer to local children's Hospital IMO.... :uhoh21:
Appreciate all input!
Last edit by mattsmom81 on Apr 28, '04
Jun 11, '04
Quote from RN34TX
Best thing for you to do!! The more I read your stuff the more I wonder if this LTAC is part of a big chain that's name starts with a "K"!!
If so I'm really glad that you are out. I've worked at one of them up in your neck of the woods and I watched them ruin peoples careers with "Group One" one right after another.
One friend of mine was falsely reported to the board. She was found innocent but it turned her life upside down for almost a year. They were always good to me personally but I quit because I was afraid that I would be next. I finally quit when a female house supervisor was asked to leave for "sexual harassment" and we all knew that the 2 nurses who accused her made it all up. She separated them to different floors because when they worked together they were so mean to other staff. So they decided to get even with her and made false accusations and she lost her job. That was the most evil place I ever worked.
:uhoh21: OMG! Yes you have guessed it...and I noticed some very dysfunctional people breeding there too...this place must be a magnet for them...LOL!! Sounds like the place you describe was the exact one I left.
Last edit by mattsmom81 on Jun 14, '04