Where are all of the Burn Unit nurses hiding?

WestCoastSunRN, MSN, CNS · Jan 4, 2017

Well here's one! But I'm not sure how much help I can give you as I am new to this specialty. My unit sounds like yours though. I'm not a new nurse -- been a critical care nurse for most of my career. But I've never worked burns OR peds -- and my unit gets peds. Does yours? I, too, would love to hear from some experienced burn nurses. In the meantime I'm studying critical care peds stuff and burn stuff where I can find it. The ABA has some good, free articles you can find in the Journal section of their website. I also read Burn Unit by Barbara Ravage. Great read for anyone -- it's not written for nurses or docs -- it's for general consumption (for the not-too-squeamish who want to learn about burn care and it's history). It's a page turner, really.

Good luck and welcome!

Cisabel · Jan 4, 2017

Thank you! They see some peds but it's not a designated place for pediatric patients. I don't see many topics or discussions with Burn nurses and I would love some insight and advice. Thank you for suggesting the book. I will definitely look it up! Good luck to you as well!

awilliamsesu · Jan 13, 2017

Hello there! I've been a burn nurse for a little over a year. Just went per diem recently in preparation for going back for my MSN. My burn center sees both adults and peds patients. Do you have any specific questions?

marienm, RN, CCRN · Jan 15, 2017

I started as a new grad on a burn unit in 2013. I work at a level 1 adult/ped trauma center teaching hospital with a children's hospital (so peds burns go there, not to my unit). My unit is very small, but we're classified as an ICU/stepdown unit and we try to keep our burn patients until they're ready for discharge. However, hospital needs sometimes dictate that we have non-burn patients, and sometimes our burn patients get moved to the med-surg floors when medically ready. Nurses from my unit don't follow them, but the same MD team does. (It's actually pretty rare for us to have *only* burn patients on the unit.)

As 'awilliamesu' says, it would be easier to answer burn-specific questions than just give you a wall of text! However, here is a different wall of text: Any new job has a lot of things to get used to--

-Make sure you're looking up policies during your orientation. At my hospital, almost everything has a policy or procedure! Want to know how much tube feed to give back to a pt when checking a residual vs. when to hold the feeding? Check the procedure. Want to know how to titrate your insulin gtt for hyperglycemia? Check the procedure. Want to know what order to draw your labs in? Check the procedure. How long can a femoral trauma line stay in place? Check the policy. Not just clinical stuff-- When and under what circumstances can you float to another floor? Check the policy. How and when can you pick vacation time? Check the policy....you get the idea. Your preceptor is (hopefully) a great resource but they are not infallible; pull the policy to be sure you've covered everything.

-Try to understand the organizational system of your workplace. Since I'm at a teaching hospital, there's a hierarchy of MDs I can call with concerns about a patient. There is no bigger waste of time than paging someone only to have them finally call back to discover they're not covering your patient anyway! On the nursing side of things, learn what your resources are: There's hopefully a charge nurse on your unit, then maybe a unit manager? Maybe you have SWAT or some other team of 'emergency' nurses who help with codes? There is probably a nursing administrator who manages staffing and bed-placement (if you're part of a larger hospital), as well as helping resolve difficult situations with a patient or family.

-Learn what the other clinical teams (RT, PT, OT, speech, dietary) do and how they can help your patient. If your patient needs a swallow evaluation, try to schedule it with the speech therapist when you & PT/OT are going to be getting them up into a chair anyway (as an example).

-Figure out how to use the phone. Transferring calls from our phones takes about 8 buttons! (We also have Voceras that we all wear...) Get comfortable talking on the phone, using SBAR format ("I'm calling about Ms. Jones of Surgery1 who had a small bowel resection on the 12th; her HR is 120 and her BP is 90/50, she's not complaining of any pain, her IV fluids are running at 100mL an hour but her urine output has declined the last 3 hours from about 80 an hour to 25 this last hour, etc...). I work nights, so the 2 residents who cover the surgery teams cover ALL the surgery teams. They don't actually know the patients well. This may not be an issue for you if your MDs only handle burns, but being concise still helps! Learn what your institution's policy is about giving out pt info over the phone. Burns are often in the local news, and you never know who is calling to check on them.

-Try to figure out what *you* need to do to be comfortable and gain confidence. As much as possible, sign up for extra training and hands-on practice sessions if they're available. Get enough sleep, don't go crazy with picking up OT, eat right, etc... Get to work on time and be ready to work. You will meet people who don't do any of these things. You may have opinions about these people...keep them to yourself!

I do check this forum occasionally and will try to answer burn questions if you post them. Good luck with your new position!

WestCoastSunRN, MSN, CNS · Jan 19, 2017

Great advice, Marienm! And thanks for responding, too, awilliamsesu!

The main question I have is how you keep proficiency in pediatrics -- or how you gained proficiency in it. I've always done adults up to now. Some of our nurses come from PICU and had to learn adults (which seems much easier to me) And how do you deal with going back and forth between peds and adults -- maybe on the same shift even.

Also, what kinds of things are protocol driven in your units? What sorts of treatments do you do or initiate without MD orders? For example, massive blood transfusions ... but it could be less critical things as well. Are your MDs there 24/7, or do you have to call them for stuff? Teaching hospitals with in house residents 24/7 will operate differently than when everyone goes home for the night.

marienm, RN, CCRN · Jan 24, 2017

Our hospital has things that are protocol driven, but they all must be initiated by an MD order. The MD can order the "hyperglycemia/insulin gtt" protocol and then the nurse can titrate the insulin per the chart, but the MD orders it first. Massive transfusion blood doesn't leave the blood bank without an order. (I think the ED's trauma bay has some O-neg blood on standby, but I don't work down there.) The MD can order the "Heparin infusion" protocol and then the nurse has to calculate the starting bolus (if ordered) and the starting infusion rate, in addition to figuring out when to draw the labs...but, again, the MD orders it first. We take fresh kidney transplants and we are usually replacing their urine output 1:1 every hour, so the nurse is changing the fluid rate hourly but the 1:1 replacement was ordered by the MD. Our burn attending is working on a nurse-titrated fluid resuscitation protocol for burn patients, but it isn't up and running yet. The MD will have to order the protocol and then the nurse will monitor urine output and adjust fluid rate accordingly.

I am at a teaching hospital so there's always a resident around to put in orders, and a couple of levels of residents above them.