Ventilator competencies

[cloggs]

I have recently been appointed as trainer for drager ventilators within my cicu. To my surprise and disbelief my managers have told me in no uncertain terms that it is not in my role to teach staff any more than how to switch the vent on, which tubes are used and which buttons to press to change settings! Knowlege of ventilation on our unit is very poor. I feel dissapointed as so many staff have asked me to teach them about ventilation, even a surgical reg. 3 of my colleagues have also been told the same and it appears to be related to the fact that a nurse who has been responsible for this area for many years is feeling threatened by us. There has been opposition to us producing a new resource file even though the one in existence has articles no more recent than 1995! We have no ventilator competencies as the said person has been 'producing' them for the past 4 yrs. I am very sensitive to colleague's needs and egos and am not the type to force my views but am frustrated at the general managerial approach in relation to this. I have worked on the unit nearly 2 years and have recently been asked to apply for a band 6 post, but am totally perplexed by this 'gagging order'. Am I being uber sensitive or does anyone else feel this situation is odd? :angryfire

[XB9S, BSN, MSN, EdD, RN, APN]

What about when new staff start, how are you able to assess competence if there are no assessment tools. How then can you deal with poor performance or staff who may be struggling if there is nothing to assess them against.

I would feel very uncomfortable about this, of course ICU nurses need to know about ventilation and have an understanding beyond turning the vents on and off.

[5cats]

I absolutly agree with Sharrie!

5cats

[XB9S, BSN, MSN, EdD, RN, APN]

Also, how can there be resistance to getting a resource file that's just silly.

You've got a couple of choices,

1. stay as you are and just do your work then go home (reading your post you don't sound like this type of person)

2. Leave and find a unit that does have this education already in place

3. Apply for and get the band 6 and then at a more senior level work to turn the education on your unit around, engage with the person who is responsible for it and work together. You've got the ideas but if you work with her then it will seem like a joint effort and she won't loose credibility. You could use it as part of your interview for the band 6 with ideas for change

Good luck

[cloggs]

I didn't apply for the band 6 post which now has someone appointed, but I have worked in senior posts previously.I have tried very hard with the vent supremo but he does not wish to discuss things with myself if I produce evidence to substantiate my points. New staff have a brief tick box generic competency package which no one follows up to see if it has been completed.Time after time I encounter innapropriate settings. Last week a patient was 'weaned' from ASB of 20 to 11 in less than 12hrs and I was asked to rest them overnight by reducing her to 10! No one reacted to her very reduced tidal volumes and increasingly high resp rate. Needless to say her support was promptly increased. I hope I don't sound sanctimonious as normally I am not outspoken at work and get on well with colleagues but this has made me despair. I have already applied for band 6 post elsewhere but would like to resolve this. Unfortunately, I am on 2wks A/L so cannot follow this up immediately. Thanks for your comments folks. It's good to let off steam.

[XB9S, BSN, MSN, EdD, RN, APN]

Cloggs have you tried getting your intensivists on board, surely they must be concerned about the lack of knowledge and education within the unit. Other than that then there is the lead nurses / clinical governance leads but it would be a long hard battle and not one to be taken on lightly.

For the patients who you find with incorrect settings your should report, incident forms. Our unit has anonymous ones which makes reporting blame free.

It sounds like you may be better off finding a more progressive unit if there is really no changing the culture,

[cloggs]

I think one of the fundamental probelms is that our unit is surgeon led, we don't have intensivists only theatre anaesthetists. The newer ones are concerned at times and glad we are trying to develop the unit. I have recently been appointed to the BACCN committee for the region and one of the anaestheists is very supportive in relation to the study events planned. Our nurse practitioners have CCU backgrounds and know little in relation to vents - they admit this themselves. Despite my recent moan I have loved working on the unit. Staff in general are very supportive and we have a great mix of overseas nurses with alot of experience. It's exciting to be part of a team that can advance practice if allowed. Guess I will have to try and iron things out with vent supremo but don't want to drag colleagues in. I need someone to be present in a meeting who is objective however so may ask my union rep. I feel sorry for him as he is 73yrs old and has a lot of experience but we can only take this into consideration to a certain point! Heather.