working in nonclosed units

[tutu123]

I am currently on a travel assignement where any dr can admit into the icu, and all of the consultants write orders. The result is having a pt with 6 different drs writing orders on one pt. And they are always conflict with their orders. I have a hard time in following the orders. The worse part is the mds at the facility do not even like to ask for input. I have to search them out and ask what changes have been made. One of my pts the other day had the ivf changes 4 times in 30 min. The only reason that I found out was I went looking for the chart and that took 45min. I this the same all over or just an isolated incident.

[nrs_grl]

We have this problem a lot in our ICU. It's too bad that we as the nurses many times gets stuck in the middle. I would love to have one ICU dr to be able to answer too. Another problem we have is residents treating patients in the ICU. I think every ICU patient needs a critical care consult!!!

[icu_nursie76]

I feel your pain. I am currently on my first travel assignment in Omaha NE and any physician can admit there pts to ICU. They do have intensivests/pulmonolgist but they don't see all the pts. I am working nocs and if the docs want like a gastro or cardiac consult we have to call them in which is a pain. Beside that the nurses are nice and it is pretty easy. take care and good luck!

[dorie43rn]

We have this problem a lot in our ICU. It's too bad that we as the nurses many times gets stuck in the middle. I would love to have one ICU dr to be able to answer too. Another problem we have is residents treating patients in the ICU. I think every ICU patient needs a critical care consult!!!

We also have residents writing orders in our ICU. This year they are actually the dumbest bunch ever! Four of them can hardly speak English. I was very proud of one of our nurses not to long ago. She called the residents in the middle of the night because her patient was tanking. Two of them came over and discussed what to do, not even asking her. Well, they decided to leave without doing anything, but the nurse yelled,"YOU ARE NOT LEAVING THIS UNIT WITHOUT GIVING ME AND ORDER FOR CARDIZEM AND LASIX! They did. But I agree, no residents giving orders in critical care!

Dorie

[racing-mom4, BSN, RN]

Our ICU is a mess as far as too many cooks in the kitchen---We have two hospitilist---they rotate M-W-F and opposite weekend, then T-TH and opposite weekend. So never there two days in a row.

Each ICU pt gets the hospitilist as consults or maybe primary(but that is rare) each pt has their own family doc that rounds on them. Then if they had surgery, the surgeon rounds on them. Heart issues--cardiac rounds on them too. Sometimes we get a surgery with a heart condition, so they get all of the above. Count it out and its 4.

OK 4. but then family doc is not on call Thursday night, so his on call doc can now write orders, that makes 5 docs who have written orders. Then something changes and the orginial hospitilist who was on at admission is now off, so other hospitilist writes orders, that is now 6 docs who have written orders.

Confusing isnt it??? Then the family docs seem to have a urinating contest with the hospitilist anymore--dont know where that tension is coming from but the nurses are caught in the middle. So family doc can write an order for Lasix 40mg and IV fluids at 75. Hospitilist comes in and thinks the Lasix order is craxy, and DCs that and writes for 2mg Bumex then ups the fluids to 125cc. Then surgeon comes in and says, we are fluid overloading, DC that 125 and take it to 50cc.

I couldnt even imagine just having 1 doc to call and one doc to get orders from, it sounds like heaven to me.

You know how many times I have called surgeon concerning his post op patient for something say like out of whack blood sugars, we talk for 10 min then he says "well lets let the hospitilist handle the sugars" so then I must call hospitilist who will say, but that is surgeons patient you need to call him. OK just did that, he said to call you.