ICU nurses pulled to general floors

[zippyRN]

Just curious if ICU nurses are being pulled to general floors? We are trying to set up a standard to prevent this from happening, just trying to get some feedback. Thank you.

the question is why?

if people are being moved when the census / acuity is low enough to tolerate this (empty beds or HDU patients in ITU beds) and to replace unforeseen absences on other wards / staff 'surge' condition in the ED then what is the issue ?

if the acuity of patients won't tolerate it then it shouldn't be happening and every time it is even requested a full clinical incident should

[zippyRN]

A question for you ...Would you want a GYN operating on your hip?? Why are nurses considered generalists when no other discipline is??? Do RT's do PT????

the question is also - do we expect a common level of core competencies among peers ?

it's not necessarily about being considered a generalist - but Nurse education worldwide is structured in such a way that it forces peopel to be 'generalists' with generalist base of practice - even in Europe with the different pre-reg 'branches' - they still produce a Generalist Adult Nurse, a generalist Mental Health Nurse, a Generalist Paeds nurse ...

becasue there is n't the requirement for higher specialist training like there is for doctors it becomes an inevitability that there is some amount of 'generalist'

back to the comparision with docs - we expect any Consultant / staff specialist / attending who works in a trauma speciality to be able to team lead a trauma case in the resus room - regardless of higher specialist certification Emergency / anaesthestics,/ general surgery / ortho / 'intensivist' / 'trauma surgeon'

[zippyRN]

In our hospital ICU nurses are not pulled to the M/S floors primarily because they are two different specialties. While a M/S RN does not have the technical expertise to manage the monitors, equipment and drips, the ICU RN does not have the generalist expertise to be able to manage a larger patient load with a broader range of diagnoses and related teaching. It just makes sense.

this is basic nursing - final placement pre-reg competnecies - while a nurse who works in a a specialist area might not be as polished as someome who has been doing it for years they shoudl be able to do this.

by 'trade' I am a Emergency Department nurse - having spent the last 4 1/2 years of the 5 1/2 years as a RN working in emergency Departments, due to service reconfigurations i've recently moved to the medicla assessment orf our sister hospital and been able to handle the work 95+% of the time - 6 patients - any medical subspeciality including level 1 cardiac care patients ( who should really be on the cardiology ward - monitors ) etc, not to mention ED admissions for head injury obs etc ...

where it falls down is when anyone would fall down - having 3 of my six patients as critical care patients 2 *levle 1 and 1 * levle (HDU) ...

[nightstar3dp]

I'm sorry, you guys may not agree with me, but I'm going to say it anyways.

The Medical-Surgical floor, in my opinion, is one of the most skilled floors there are. Each and every department is a special area whether it be ICU or Peds. In my hospital if you work in the MS floor you have to know what your doing because we see EVERYTHING, we even have to take overflow from other departments are full including ICU/OB/Peds. We take care of fresh surgical patients, granted on nights ICU recovers them.

At my hospital, nurses who float do NOT have to take a team of patients. When they float they typically help us out by doing admission assessments, IVPs, or hanging antibiotics. A nurse regardless of where he/she is from should not have to take patients in any department they are not 'oriented' to, but expecially a MS floor. I work nights and often we do not have enough staff because there is simply not enough of us and I can have anywhere between 5-12 patients. Is this dangerous, well yes, am I capable of handling it... yes.

Even the most experienced nurse can have difficulty on the MS floor, you can be a nurse for 30 years, been off the floor for 15.. try to come back and struggle... trust me i've seen many nurses come and leave the floor.

[Neversettle71]

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I'm sorry, you guys may not agree with me, but I'm going to say it anyways.

The Medical-Surgical floor, in my opinion, is one of the most skilled floors there are. Each and every department is a special area whether it be ICU or Peds. In my hospital if you work in the MS floor you have to know what your doing because we see EVERYTHING, we even have to take overflow from other departments are full including ICU/OB/Peds. We take care of fresh surgical patients, granted on nights ICU recovers them.

At my hospital, nurses who float do NOT have to take a team of patients. When they float they typically help us out by doing admission assessments, IVPs, or hanging antibiotics. A nurse regardless of where he/she is from should not have to take patients in any department they are not 'oriented' to, but expecially a MS floor. I work nights and often we do not have enough staff because there is simply not enough of us and I can have anywhere between 5-12 patients. Is this dangerous, well yes, am I capable of handling it... yes.

Even the most experienced nurse can have difficulty on the MS floor, you can be a nurse for 30 years, been off the floor for 15.. try to come back and struggle... trust me i've seen many nurses come and leave the floor.
__________________
J. Tworoger, LPN
Medical-Surgical
Emergency Department
Currently Overloaded RN Student

Nightstar,
I try very hard to be the voice for professionalism. I keep a calm head and supportive. I must really ask: Did you have a preceptor or mentor? If you did please find a new one. They are doing you a disservice. Your post was unbelieveably arrogant for your stated experience level. The fact that you might actually believe that you can do it all with no experience is one of the scariest things I've ever heard. If you survive in this field one day you will look back on this attitude and shudder.
I hope that you realize the positions of LPN and RN are different. They not only have different duties but levels of responsibility as defined by your state's Nurse Practice Act.
To directly address your comments that left me with the impression that you look down on the abilities of ICU nurses let me give you a brief overview of an average ICU patient:
Diagnosis: Septic Shock with ARDS. The patient is vented, CVC, ART line, multiple gtts (Diprivan, Levophed, Insulin, IVF)

I am sure that means absolutely nothing to you. How often would you check VS? Why? What would you adjust? Blood Glucose Levels? When would you notify the MD? Which labs/tests would show an improvement for what diagnosis?

While I am not your preceptor let me clue you in with a brief overview (free handed) of this one (out of 3 assigned) patient: HR, ABP and NIBP q 2 minutes until titration of Levphed stable then q 5 minutes (BTW YOU are titrating so don't kill him); UOP q 1 hour; CVC q 30 min.; Blood glucose q 1 hour with insulin drip titration ( remember DON'T kill him - it's IV insulin not SQ); watch for extravasation and have your regitine on hand; oral care at LEAST q 1 hour including ET care; turn q 2hours; verify NG tube placement q 4 hour by aspiration and auscultation; check for residual and adjust feeding; monitor Ramsey scale closely so as not to hinder progress with ARDS; Lytes will be checked q 4 hours - interpret results and inform MD if not in line with progression; level and flush CVP and ABP q 1 hour; zero CVP and ABP q 4 hours; maintain HOB > 30 degrees at all times; head to toe assessment q 4 hours; not to mention bathe patient; and we won't discuss unusual requirements like giving blood etc. Finally perform a line draw for all labs and DON'T forget your other patients.

Whether this looks like a lot to you remember: the level of acuity is different between ICU and Med/Surg. I have all of the respect in the world for Med/Surg nurses, but the focus is different. No Med/Surg nurse floating to ICU would be required to take true ICU patients, it would be unfair and dangerous. There are no similar restrictions on floating ICU nurses to the floor. Most nurses in my experience assume that because you are an ICU nurse you can do whatever they float your way without taing into account that you are out of your element. Remember this. Floating takes a nurse out of her normal thought process and places him/her into another realm. He/she SHOULD feel uncomfortable.

Moderator Edit; Sir, I consider you a very valuable member. I have enjoyed reading many of your past post. However, I do think a misunderstanding is taking place between you & Jeremy, aka nightstar3dp. IMHO, he did not mean to come off arrogant, or to belittle the expertise required of critical care nurses. His profile reads him to be younger than my kids... damn, we are not getting any younger are we? So, maybe a communication generation gap has occurred between the two of you? However, let us all try to be more relaxed within this heated thread, okay?

Thanks!

[nightstar3dp]

Ok, first off, you misread my comments entirely. Second you should not even begin to judge my level of experience when you have no clue as to what experience I have in any department whether I am a LPN or RN. I realize the duties are different, where as the care I can provide to a patient may be slightly less limited then a RN, however, I am fully capable of handling any experience or acuity level my hospital can keep and take care of within my hospital's capabilities, because I have been oriented and have worked in ICU, ER, and Med-Surg units as a STAFF nurse. Oh, and another thing... as long as there is a Registered Nurse there in the ICU with me, those drips... ,according to my Nurse Practice Act, as long as they are premixed or prediluted (Please remember we have a Pharmacist at our hospital 24/7) I can hang them. I can draw blood out of any line with the proper training and documentation. I can monitor any breathing machine up to and including a VENT. Oh, and please, let me ask you a question... when you don't know something... what do you do? Well, since you are probably a nurse I would assume you'd look it up. I am quite capable of looking up medications and procedures, and I look frequently at my state's nurse practice act to make sure I am not over stepping my shoestrings. No, I may not be able to initiate blood, but guess what, as long as the RN documents no reactions after 15 minutes, I can monitor, stop it, discontinue it, and even change the cc/hr.

I work in a small rural hospital where we don't often see the critical care patients with the illness you have mentioned, most of them with those type of symptoms are contained in the ER and air-lifted to a bigger hospital so wider ranged capabilities and a higher acuity levels can be met, however I would be interested to know how to take care of those patients like you would, I can almost promise you not even the ICU RNs on staff at my hospital have hung some of the drugs you have listed, which means in the event, they would look it up to!.

Now to the point I was trying to make, please don't read into it, I would hate for you call my comments arrogant again. Everyone always downs the medical-surgical floor, nobody ever wants to work them, which is part of the reason a med/surg floor is always short staffed. When there is a staff nurse, whether it be a ICU/Peds/OB/PSYCH/ER nurse that floats to OUR med/surg we do not make them take patients, its a hospital policy. I never once stated anywhere ICU does not see a higher acuity of patients, because I know they do. I simply said on the medical-surgical floor there are a more variety of patient conditions that can fall apart at any moment and sometimes, 4/10 there isn't a ICU bed to transfer him to.. so guess who has to take care of the patient and attempt to stabelize him while a bed opens?

BTW nice case study, I will relate back to this if and when something happens as you describe. Just because I am a LPN and not a RN I'm not stupid or inferior to anyone. If I don't know something I will look it up or ask somebody to help me.

Moderator Edit; No one is accusing anyone of being stupid. However, let us all try to be more relaxed within this heated thread, okay? Thanks!

[TomB]

I work in a trauma center but before this I worked in the Neuro ICU. The patients were very complex with multiple drips, vents, trauma, etc. I was very good at taking one or two patients at a time, dealing with devastated families, ****y neurosurgeons, clueless residents and sleepy intensivists, etc.

A few times I was pulled to a MS floor. I had the skills, right? WRONG!! I was lost. The nursing was completely different. I had multiple patients that were conscious! I had no monitors telling me what was going on. No continuous biox, no vent alarms, no nothing. It wasn't that the nursing was harder, but it was just different. If I had been completely oriented to the unit I would have done better. I was running around like a chicken with its head cut off.

I think we all should respect each other's speciality. I don't think I'm a better nurse because I work critical care. It's just a different skill set. I respect all nurses that do bedside care.

[SoldierNurse]

I work in a trauma center but before this I worked in the Neuro ICU. The patients were very complex with multiple drips, vents, trauma, etc. I was very good at taking one or two patients at a time, dealing with devastated families, ****y neurosurgeons, clueless residents and sleepy intensivists, etc.

A few times I was pulled to a MS floor. I had the skills, right? WRONG!! I was lost. The nursing was completely different. I had multiple patients that were conscious! I had no monitors telling me what was going on. No continuous biox, no vent alarms, no nothing. It wasn't that the nursing was harder, but it was just different. If I had been completely oriented to the unit I would have done better. I was running around like a chicken with its head cut off.

I think we all should respect each other's speciality. I don't think I'm a better nurse because I work critical care. It's just a different skill set. I respect all nurses that do bedside care.

My sentiments, exactly!

IMHO, the Med/Surg nurses should not be required to float to ICU & vis versa. However, I see nothing wrong with an experienced telemetry nurse [Stepdown Unit staff] floating to ICU, and an ICU nurse floating to a Stepdown Unit. LOL, my wife works on a Stepdown Unit down the hall from where I work in ICU. We have helped each other out [one of us off the clock] before when one us gets off at 1500 and the other at 1900.

I admire the Med/Surg nurses with how well organized & how well they prioritize. Yet, on the same token I don't think everyone is cut out to be a critical care nurse with their patient's life literally in the balance between life or death... shift after shift.

[justatraveler]

I work in a trauma center but before this I worked in the Neuro ICU. The patients were very complex with multiple drips, vents, trauma, etc. I was very good at taking one or two patients at a time, dealing with devastated families, ****y neurosurgeons, clueless residents and sleepy intensivists, etc.

A few times I was pulled to a MS floor. I had the skills, right? WRONG!! I was lost. The nursing was completely different. I had multiple patients that were conscious! I had no monitors telling me what was going on. No continuous biox, no vent alarms, no nothing. It wasn't that the nursing was harder, but it was just different. If I had been completely oriented to the unit I would have done better. I was running around like a chicken with its head cut off.

I think we all should respect each other's speciality. I don't think I'm a better nurse because I work critical care. It's just a different skill set. I respect all nurses that do bedside care.

Frankly, monitors lie.

[cassioo]

my problem with pulling in general was (I'm on a closed unit now no pulling to or from) some of us have experience in other areas and when we'd get pulled we would have to do more/different things then our co-workers when they got pulled or the supervisors would want to pull some of us when it wasn't our turn in the rotation because they wanted us to work that unit as a staff nurse even though our pull policy said if our unit got busy you went back to the home base. I would end up on M/S and yes I can do it...been there done that but it's not what I choose to do right now and a couple of my co-workers would end up in ICU (they still pull overtime hours there). I wouldn't want to be pulled to ICU (done it a couple of times and was assigned the OD's and got to give charcoal everytime) I also don't want nurses pulled to my floor (they don't want to come either)...I'm in labor and delivery. Everyone has their place and you can't be an expert in all of them...I don't want an ICU or M/S nurse titrating my pitocin sure they can do it all you do is increase the rate by 6ml/hr every 15-30 minutes until you get what you want but it's the knowing what you want to get is the trick and reading a few monitor strips in school isn't it. Can't we all just get along