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.
ICU nurses pulled to general floors
Usually when a nurse is pulled to another floor, she is given the worst assignment there. They usually have no idea what is happening and accept the assignment before knowing what they are getting into. Being cross-trained is going to become necessary as our economy worsens and the supply of nurses dwindles. I would suggest that nurses seek to cross-training before being madet to. Several of our PACU nurses work in the ED and OR. If you are in the planning stages then PLEASE plan ahead and don't thrust this on staff. Get them involved in the process. Ask them where they might want to cross-train. Offer an afternoon shadowing a nurse from that unit in order to get a feel for the specialty. Start an inservice program for nurses who want to cross-train and offer an hourly compensation to work off the regular unit. Don't be penny wise and pound foolish. You get out of something equal or better that which you invest when it is with people.
Why is it a problem for ICU nurse to be pulled to general medical floors? I would see a problem if a med/surg nurse were pulled to work in the ICU. Granted, it is not an ideal situation to pull a nurse from one unit and float them to another. I guess I am just having trouble understanding the point of this particular thread. 
I am an ICU nurse, and yes, we sometimes get pulled to other floors, and yes we sometimes get the worst assignments, and yes we are sometimes left in the weeds by the staff on those units... but think about it;
Are we not some of the more higher skilled nurses? Not better, mind you, just equipped with a broader skill mix? And with this broad skill mix, and expertise, are we not better able to handle the worst assignments?
Sure, I would rather stay on the unit and care for the more critically ill patients, but we are all in this thing together, and personally, I really don't mind lending a hand where it is needed... if indeed it is truly needed.
Now, if I am sent to another unit just because some staffing idiot just can't see the forrest for the trees, that's a different story all together. In any case, the other nurses will appreciate my assistance, and I am always grateful at the end of the day that it is not me in that hospital bed.
Are we not some of the more higher skilled nurses? Not better, mind you, just equipped with a broader skill mix? And with this broad skill mix, and expertise, are we not better able to handle the worst assignments?
Sure, I would rather stay on the unit and care for the more critically ill patients, but we are all in this thing together, and personally, I really don't mind lending a hand where it is needed... if indeed it is truly needed.
Now, if I am sent to another unit just because some staffing idiot just can't see the forrest for the trees, that's a different story all together. In any case, the other nurses will appreciate my assistance, and I am always grateful at the end of the day that it is not me in that hospital bed.
Hi all.
The problem is this: When they pull ICU nurses to the floor, they are assuming since the ICU nurses are so skilled, that they are teh jack of all trade nurses and can handle anything. The is true in the sense of one sick patient - ICU nurses are very much skilled in the situation of one or two sick patients.
Being pulled is ok when you have had the experience of 6 patients who are minimally sick. BNut when a nurse started in teh ICU out of school they are not experienced in the floors. To have 6 patients who are only minimally sick, and need 50 pills each, it is something taht they are not experienced in. That is where the problem arises. ICU nurses should stay where they are trained, and floor nurses whould stay where they are trained. At least they should try to only send ICU nurses with floor experience.
The problem is this: When they pull ICU nurses to the floor, they are assuming since the ICU nurses are so skilled, that they are teh jack of all trade nurses and can handle anything. The is true in the sense of one sick patient - ICU nurses are very much skilled in the situation of one or two sick patients.
Being pulled is ok when you have had the experience of 6 patients who are minimally sick. BNut when a nurse started in teh ICU out of school they are not experienced in the floors. To have 6 patients who are only minimally sick, and need 50 pills each, it is something taht they are not experienced in. That is where the problem arises. ICU nurses should stay where they are trained, and floor nurses whould stay where they are trained. At least they should try to only send ICU nurses with floor experience.
Well put, bluesky.
Hi Sasperger,
Are you having any success preventing your ICU nurses being pulled to unfamiliar floors?
I think "pulling" is a terrible policy & wish something could prevent it alltogether. First of all it's very demoralizing to the staff affected by such policies because they accepted a job in one particular practice area & then come to discover that they are subject to being forced to work in all sorts of unfamiliar settings without notice.
That can give a person a sinking feeling and a dread of going to work!
While it is true that ICU Nurses are the greatest when it comes to handling the care of their ICU patients that doesn't mean they should be expected to walk into an unfamiliar unit and smoothly take on caring for a mixture of patients with all sorts of different medical conditions, unfamiliar doctors, different charting, unknown routines and supply areas.
Think about it.. nurses who routinely work those floors get an orientation to the unit- they aren't just thrust in one day & told good luck!
To a nurse used to working with one specialty set of patients (in this instance ICU patients) it can be quite disconcerting to suddenly be confronted with patients who need various types of preps for this or that that the nurse may not be at all familiar with.
How would an ICU nurse (or OR Nurse, or NICU Nurse) know offhand what prep to give to someone getting a GI series for example? Think about the differences in charting even! Lots of difference between charting in the ER or ICU, or OR than on a floor. I'd say pulling nurses around is a lose-lose situation for the patients and the nurses.
The hospital should put more effort into building up a larger base of per diem or pool nurses to call in to fill staff shortages and not pull nurses around in my opinion.
It's putting your license at risk and your morale in the dumpster! Pulling policies suck.
There.. not elegant but that's my opinion about forcing nurses to work unfamiliar units. Best of luck stopping administration from doing it! Let us know how it's going please?
Sara
Are you having any success preventing your ICU nurses being pulled to unfamiliar floors?
I think "pulling" is a terrible policy & wish something could prevent it alltogether. First of all it's very demoralizing to the staff affected by such policies because they accepted a job in one particular practice area & then come to discover that they are subject to being forced to work in all sorts of unfamiliar settings without notice.
That can give a person a sinking feeling and a dread of going to work!
While it is true that ICU Nurses are the greatest when it comes to handling the care of their ICU patients that doesn't mean they should be expected to walk into an unfamiliar unit and smoothly take on caring for a mixture of patients with all sorts of different medical conditions, unfamiliar doctors, different charting, unknown routines and supply areas.
Think about it.. nurses who routinely work those floors get an orientation to the unit- they aren't just thrust in one day & told good luck!
To a nurse used to working with one specialty set of patients (in this instance ICU patients) it can be quite disconcerting to suddenly be confronted with patients who need various types of preps for this or that that the nurse may not be at all familiar with.
How would an ICU nurse (or OR Nurse, or NICU Nurse) know offhand what prep to give to someone getting a GI series for example? Think about the differences in charting even! Lots of difference between charting in the ER or ICU, or OR than on a floor. I'd say pulling nurses around is a lose-lose situation for the patients and the nurses.
The hospital should put more effort into building up a larger base of per diem or pool nurses to call in to fill staff shortages and not pull nurses around in my opinion.
It's putting your license at risk and your morale in the dumpster! Pulling policies suck.
There.. not elegant but that's my opinion about forcing nurses to work unfamiliar units. Best of luck stopping administration from doing it! Let us know how it's going please?
Sara
I for one am way more concerned with floor nurses pulled to the ICU. It is dangerous and fits the mentality of "a nurse is a nurse" Would a medical supervisor demand a cardiac surgeon perform brain surgery just for one shift? any thoughts?
I'm with you Latinanurse.. it outta be illegal 
Hey all,
This is my first post on this website, so bear with me.
I've been an ICU nurse for about 8 years now. And that's all I know. Give me a Swan, Balloon Pump, SVO2 monitor, and Levo, Dopamine, and Dobutamine...and I'm set. ICU was my first job out of nursing school and I love it. I knew it was what I wanted to do from the start. I was even a PCT in the ICU for two years before starting in that same ICU.
Now, I don't have a clue what the theraputic Aminophyline or Lithium levels are unless I look at a book. Not an every day thing in the ICU. I don't usually give 20 oral meds to one patient in a shift, let alone giving that many meds to 6-7 patients.
My charting consists of extemely detailed, sometimes minute to minute changes, especially for new open hearts or transplants.
So I tell you, when I float to another unit that doesn't have q1hour vitals as a standard, or the lovely chime of a vent or balloon pump in the background.....I'm lost.
I'm all for helping out our fellow nurses, but understand that when you get an ICU nurse in a floor setting like me...Expect a novice!!! ICU nurses have a different mind set all together. Floor nurses are probably the most organized nurses I've ever seen. How they handle 6-8 patients, I have no clue. True they are more stable, but that's just the point. Even the stable ones in ICU get ICU care...please tell me if I'm wrong.
SO, In a nutshell, I'm not completely against floating if it is in dire need, but I may be more of a hinderance than help because I'm not afraid to ask questions or for help if I really need it.
And besides all that, most of us went into our specialties because that's what we wanted to do. If hospitals are expecting nurses to know what to do when floated to other units, don't you think there should be a little float bonus attached to the hourly pay? (I used to be an ICU manager also and tried to push admin into giving a float bonus...almost brought the nurses to agency pay) Just a thought. Keeps our nurses in the hospital, gives them an incentive to learn something about other units, and cross trains nurses to be more proficient in other settings of the hospital.
Sorry, my thoughts are all over the place. But that's all I have to say about that....
This is my first post on this website, so bear with me.
I've been an ICU nurse for about 8 years now. And that's all I know. Give me a Swan, Balloon Pump, SVO2 monitor, and Levo, Dopamine, and Dobutamine...and I'm set. ICU was my first job out of nursing school and I love it. I knew it was what I wanted to do from the start. I was even a PCT in the ICU for two years before starting in that same ICU.
Now, I don't have a clue what the theraputic Aminophyline or Lithium levels are unless I look at a book. Not an every day thing in the ICU. I don't usually give 20 oral meds to one patient in a shift, let alone giving that many meds to 6-7 patients.
My charting consists of extemely detailed, sometimes minute to minute changes, especially for new open hearts or transplants.
So I tell you, when I float to another unit that doesn't have q1hour vitals as a standard, or the lovely chime of a vent or balloon pump in the background.....I'm lost.
I'm all for helping out our fellow nurses, but understand that when you get an ICU nurse in a floor setting like me...Expect a novice!!! ICU nurses have a different mind set all together. Floor nurses are probably the most organized nurses I've ever seen. How they handle 6-8 patients, I have no clue. True they are more stable, but that's just the point. Even the stable ones in ICU get ICU care...please tell me if I'm wrong.
SO, In a nutshell, I'm not completely against floating if it is in dire need, but I may be more of a hinderance than help because I'm not afraid to ask questions or for help if I really need it.
And besides all that, most of us went into our specialties because that's what we wanted to do. If hospitals are expecting nurses to know what to do when floated to other units, don't you think there should be a little float bonus attached to the hourly pay? (I used to be an ICU manager also and tried to push admin into giving a float bonus...almost brought the nurses to agency pay) Just a thought. Keeps our nurses in the hospital, gives them an incentive to learn something about other units, and cross trains nurses to be more proficient in other settings of the hospital.
Sorry, my thoughts are all over the place. But that's all I have to say about that....
CCRNMaui when I used to work in SICU I remember being pulled to a floor once or twice & it drove me absolutely nuts that I could see all of my patients all the time- so I was constantly walking the hall peeking in & checking patients every 15 minutes- in between trying to keep up with everything to do. Absolutely maddening experience! *LOL*
There are so many adv vs disadvantages to floating....
Like you, I feel out of my realm. If they have team nursing or functional nursing you can offer to do the things you're familiar with...passing meds, doing treatments, etc. This cuts down on the amount of charting you have to do
Got pulled to post partum once.... volunteered to take the c-sec, I know surg pts...but all were on IVs with no pumps,,,ran around all night trying to get my gtts right!! At least they had foleys , incisions, things I knew how to deal with!!
I also worked in a closed unit...we never got pulled, but on the other hand, we couldn't pull anyone either....had to cover ourselves, so we had mandatory call time. Not the ideal solution, but it proevents you from being pulled to a unit you feel uncomfortable with.
There are solutions,you just have to find those that work for your facility.
mercynurse
Like you, I feel out of my realm. If they have team nursing or functional nursing you can offer to do the things you're familiar with...passing meds, doing treatments, etc. This cuts down on the amount of charting you have to do
Got pulled to post partum once.... volunteered to take the c-sec, I know surg pts...but all were on IVs with no pumps,,,ran around all night trying to get my gtts right!! At least they had foleys , incisions, things I knew how to deal with!!
I also worked in a closed unit...we never got pulled, but on the other hand, we couldn't pull anyone either....had to cover ourselves, so we had mandatory call time. Not the ideal solution, but it proevents you from being pulled to a unit you feel uncomfortable with.
There are solutions,you just have to find those that work for your facility.
mercynurse
We are a self contained critical care unit. We may have to work a little more over time, but we cover one another. We also have an on call 8 hour manditory sign up sheet. We sign up or we are signed up. It works out ok.
Please don't take this wrong. I feel for ICU nurses who get floated to M/S. They just are not used to working with so many patients, anymore than I could get used to having only 2 patients. We just have different priorities formed in our brains. I know ICU nurses work hard and are intelligent good nurses they just work and think differently..
There is nothing wrong with that. I am scared to death of vents..
WR,,, three commas for Becca
There is nothing wrong with that. I am scared to death of vents..
WR,,, three commas for Becca
You do not understand the role of the ICU nurse. I've worked both in General Peds and PICU. They are different worlds. Once indoctrinated into the PICU there was no going back. Everything is different. Right now I'm in peds LTC, and that's different too. I'm going back to my general peds experience, and the Dr and FNP are not liking it. I'm used to doing things on my own. You have to think quick in ICU. This was my choice, but on the whole I don't think ICU nurses should be pulled to work on M/S floors. 
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<font face="Comic Sans MS">Text</font><font color="green">Text</font> <span style="background-color:white">Text</span> I used to work ICU, now work ER. Back in those days, we would "pull" a floor nurse to take our STABLE pts., you know, those pts. who should have been on the tele floor, but their MD wanted them in the ICU instead. Great nurses, loved them!! We would also be pulled to the tele floor, those nurses gave us the 'easy' patients, or we would help out passing the meds, starting IV's, helping with baths, etc. After all these years in the ER, I have learned to appreciate each speciality, M/S, ICU, Peds, etc. Could I do what those nurses do? No way!! Why should a speciality nurse be floated to another unit? Would an OB/GYN accept being floated to the ICU? Would a cardiologist deliver a baby? Why should a speciality nurse?
So true...We LOAO once when our ortho guy said he heard the page..."Any MD to the OR stat". And he ran from PACU back into the OR.. They were "in the process" of a C-section and a foot dropped out of the vagina.. The OR nurse ask the ortho guy what do you think..He said "I think it's a foot"...LOLLLL
WR,,, three commas for Becca
WR,,, three commas for Becca
Is there an organization for RN's to get concerns turned into realities? If some of these ideas didn't turn into law, at the very least it could be a 'look up' list of hospitals that do XYZ instead of the miserable ABC. A black list of sorts but more importantly, a list of good hospitals to work at for RN's (I can't help myself, my father is a lawyer so my head goes in that direction).
I see a lot of caring good people who think they don't have a voice. What is the figure? 2,000,000 Registered Nurses in the US!!! That's a lot of people!
Jeannie
I see a lot of caring good people who think they don't have a voice. What is the figure? 2,000,000 Registered Nurses in the US!!! That's a lot of people!
Jeannie
You might not like this post so ignore if you want to..
If you find two nurses who agree the sky is blue let me know.
Nurses are not notoriously pack animals. Usually all for one and one for one..JMHO
WR,,, three commas for Becca
If you find two nurses who agree the sky is blue let me know.
Nurses are not notoriously pack animals. Usually all for one and one for one..JMHO
WR,,, three commas for Becca
Boy that's the truth. To get solidarity in nursing would be a good trick. You can have ten nurses mad about something that happened in the unit. But you will only find two who will do something about it. The rest do not want to make waves.
Then you have one or two that make waves, but it is usually against other nurses, NOT management.
to get back on topic, I have never worked on the floor. I think most nurses that work the floor are very special people. I think after one day I would hang myself.
Then you have one or two that make waves, but it is usually against other nurses, NOT management.
to get back on topic, I have never worked on the floor. I think most nurses that work the floor are very special people. I think after one day I would hang myself.
Maybe...and this is just a thought...since you have to have continuing credit hours anyway to keep license current, maybe the facilities you work for should hold training sessions for the different units. Kill 2 birds with one stone, that could possibly count towards credit, right???
I am a student and my aunt suggested that I read some of these posts to get a feel for what I am actually getting into as a prospective nurse.
I know in Michigan, your license is good for 2 years expiring every 31st March. To be current you need at least 25 cont credits in the time frame. It just makes sense to me that you could have a crash course, if you will, to teach at least the basics of the different areas. The managers or team put together by the manager could write out the curriculum( this counts as credit also) and the nurse who actually instruct should be given credit as well. Maybe a naieve suggestion, but as they say out of the mouths of babes....
I am a student and my aunt suggested that I read some of these posts to get a feel for what I am actually getting into as a prospective nurse.
I know in Michigan, your license is good for 2 years expiring every 31st March. To be current you need at least 25 cont credits in the time frame. It just makes sense to me that you could have a crash course, if you will, to teach at least the basics of the different areas. The managers or team put together by the manager could write out the curriculum( this counts as credit also) and the nurse who actually instruct should be given credit as well. Maybe a naieve suggestion, but as they say out of the mouths of babes....
Many states don't require ANY CEU's for renewal..
WR,,, three commas for Becca
And it's not that ICU nurses don't know what to do on a Med/Surg floor.. It's the need to take care of 4-8 patients. It's hard to teach priorities and time management.That is a learned skill .. IMHO..
WR,,, three commas for Becca
And it's not that ICU nurses don't know what to do on a Med/Surg floor.. It's the need to take care of 4-8 patients. It's hard to teach priorities and time management.That is a learned skill .. IMHO..
I think my hospital might do something like that as an inservice but I don't know that they would be granted CEU credits for the class by the state who has to approve CEU's.
I think nurses might protest loudly. They do give a general orientation to other units when hired but depending on the shfit you work and who you work with you might not get pulled to another unit for a year or you might get pulled the next week. If it's a long time between pulls things change.
I think nurses might protest loudly. They do give a general orientation to other units when hired but depending on the shfit you work and who you work with you might not get pulled to another unit for a year or you might get pulled the next week. If it's a long time between pulls things change.
My wife works in a Union Shop and they've addressed this in their contracts. An ICU nurse can only be pulled to either PCU or Telemetry. Ideally after an orientation to the unit, though only a few nurses have actually had the orientation before they were pulled.
Andrew Lopez, RN
http://www.nursinghumor.com
Andrew Lopez, RN
http://www.nursinghumor.com
When I spoke of the Continuing ed credits, I was speaking in terms of states that have those requirements. I don't know what state you are in but in Michigan that is required.They even explain how to go about having programs like what I mentioned approved by the board. There are limits to how many hours you can recieve, but it seems to be so vast that it would still be worth it. Maybe it should be required in other states as well. My information comes from The Administrative Rules of the Michigan Board of Nursing, part 6 Continuing Education, R.338.10601 and R338.10602. PP. 20-22(Last Rev. 12/19/2003, reprinted 5/5/2004)
As far as priorities and time management, a learned skill... yeah. It takes time however to develop it, I think that's where the additional courses come in handy for higher degree(BSN or higher) seeking nurses. From what my instructors( all hold a minimum of a BSN, some have Master's)and classmates(LPN,ADN, and some that are fresh like me who just decided to get a BSN) the difference between them: LPN's=clinical, ADN=clinical + theory, BSN=clinical+theory + Management.
Management teaches most people how to prioritize by using rationale and logic, and having you use an analysis theory to put it in place while on the job. A good example of this is dimensional analysis, or in nursing, the factor label method. My dad is an engineer and he explained to me about dimensional analysis in such a way that when I begin the pharmacologic portion of my curriculum it was a breeze for me while my other classmates struggled. The examples he used were in no way of a medical nature but I was able to correlate them with what I learned in class.
That is not to say you can't learn it on the job but there are courses that you can take to help you out. At my school they offer Nurse Management and Leadership and Critical Thinking. The one thing they all stress and our instructors keep telling us nursing is sequential. If we don't master our current course, it will just get more difficult as we proceed.
As far as priorities and time management, a learned skill... yeah. It takes time however to develop it, I think that's where the additional courses come in handy for higher degree(BSN or higher) seeking nurses. From what my instructors( all hold a minimum of a BSN, some have Master's)and classmates(LPN,ADN, and some that are fresh like me who just decided to get a BSN) the difference between them: LPN's=clinical, ADN=clinical + theory, BSN=clinical+theory + Management.
Management teaches most people how to prioritize by using rationale and logic, and having you use an analysis theory to put it in place while on the job. A good example of this is dimensional analysis, or in nursing, the factor label method. My dad is an engineer and he explained to me about dimensional analysis in such a way that when I begin the pharmacologic portion of my curriculum it was a breeze for me while my other classmates struggled. The examples he used were in no way of a medical nature but I was able to correlate them with what I learned in class.
That is not to say you can't learn it on the job but there are courses that you can take to help you out. At my school they offer Nurse Management and Leadership and Critical Thinking. The one thing they all stress and our instructors keep telling us nursing is sequential. If we don't master our current course, it will just get more difficult as we proceed.
Boy oh Boy are you gonna get slammed.. In the last hospital I worked in none of the BSN educated nurses including myself were in charge...I have seen many BSN nurses who couldn't punch their way out of a wet paper bag and an ADN educated RN who could manage 43 patients with her eyes closed.
You may think that priority setting can be taught or organizational skills can be taught I disagree.. I would love to be an artist but I have no artistic talent. I don't think you can teach someone to be a great chef. I think many skills are innate.. In other words you have the skill or not..Yes it can be enhanced but it can't be taught.
And as Cass said things change rapidly in almost any field of nursing and it's the old use it or lose it senario.. Surgeons change with the wind and most of them are very fussy and don't follow the textbooks.. We used to have a surgeon that hated those thick pads.. He didn't like his incision wet.. And he'd throw them at you if you gave them to him.. But how would a float nurse know that...He was a sweet heart really and devoted to his patients just figured a nurse would know what to do for him..
The compact is 16-17 states ( I can't remember how many right now and I'm not looking it up) and none of them require CEU's and I'm sure there are many more that don't..Sometime when I'm not busy I'll check out them all and get a %.
What this country needs is a National Nursing License. We all take the same test now and those who took the old test have enough experience if they have been working regularly to qualify for a National Nurse License.
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????
WR,,, three commas for Becca
You may think that priority setting can be taught or organizational skills can be taught I disagree.. I would love to be an artist but I have no artistic talent. I don't think you can teach someone to be a great chef. I think many skills are innate.. In other words you have the skill or not..Yes it can be enhanced but it can't be taught.
And as Cass said things change rapidly in almost any field of nursing and it's the old use it or lose it senario.. Surgeons change with the wind and most of them are very fussy and don't follow the textbooks.. We used to have a surgeon that hated those thick pads.. He didn't like his incision wet.. And he'd throw them at you if you gave them to him.. But how would a float nurse know that...He was a sweet heart really and devoted to his patients just figured a nurse would know what to do for him..
The compact is 16-17 states ( I can't remember how many right now and I'm not looking it up) and none of them require CEU's and I'm sure there are many more that don't..Sometime when I'm not busy I'll check out them all and get a %.
What this country needs is a National Nursing License. We all take the same test now and those who took the old test have enough experience if they have been working regularly to qualify for a National Nurse License.
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????
WR,,, three commas for Becca
Slammed, I think not. Everyone is entitled to an opinion. We will just have to agree to disagree. I have written my posts based on what I have and am currently learning in school and from what I am being told by my peers, classmates, and instructors.
I believe it can be taught if you are open-minded enough to want to learn and listen to those who have been there and done that.Also bear in mind there is a difference between right and left brain functions. Creativity...maybe that can't be taught but logic, I believe it can.
My great-great grandmother was a midwife. Her 2 favorite sayings were that there is nothing new under the sun( it just may appear in a different form) and I've been your age, you've never been mine. What I gleam from those statements is that God gave me 2 ears and one mouth for a reason. Listen twice and learn something before speaking.A person should not let other people's opinions of them prevent them from doing what they know they can. If other people can do it so can I.
When I first started school, I was having a hard time in one of my classes (not nursing) to the point I wanted to quit. I went to my dad( an engineer who also taught high school calculus/trig, computer science, and elect/digital electronics) and he said to me,"Baby, you don't have to be smart to graduate from college, you only need to be dedicated. If you want it you can have it".
What it all boils down to is this, if you want to do it...do it.
I intend to.
P.S.
I didn't write the curriculums for LPN, ADN, and BSN's. That is what it appears to be and according to people who have actually finished those programs, that's what it amounted to.
I believe it can be taught if you are open-minded enough to want to learn and listen to those who have been there and done that.Also bear in mind there is a difference between right and left brain functions. Creativity...maybe that can't be taught but logic, I believe it can.
My great-great grandmother was a midwife. Her 2 favorite sayings were that there is nothing new under the sun( it just may appear in a different form) and I've been your age, you've never been mine. What I gleam from those statements is that God gave me 2 ears and one mouth for a reason. Listen twice and learn something before speaking.A person should not let other people's opinions of them prevent them from doing what they know they can. If other people can do it so can I.
When I first started school, I was having a hard time in one of my classes (not nursing) to the point I wanted to quit. I went to my dad( an engineer who also taught high school calculus/trig, computer science, and elect/digital electronics) and he said to me,"Baby, you don't have to be smart to graduate from college, you only need to be dedicated. If you want it you can have it".
What it all boils down to is this, if you want to do it...do it.
I intend to.
P.S.
I didn't write the curriculums for LPN, ADN, and BSN's. That is what it appears to be and according to people who have actually finished those programs, that's what it amounted to.
Sweety you are right you haven't been my age.. I graduated two of those programs.. I was an LPN for 17 years and am now a BSN educated RN.. I heard all the "stuff" you are hearing now.. And I believed it the first time only to be hit by reality shock upon graduation.. LPN school taught me more about priority setting than the BSN classes ever could. I taught several labs in my BSN program ..Like how to hang blood, how to suction and the instructor was an NP.. She hadn't worked in a clinical setting ever I think..Got her BSN went right into her NP program.. Many of the instructors haven't set foot in a clinical situation.
And you are right you don't have to be smart or even dedicated to graduate college..You just have to leave your common sense at the door...Just make sure to pick it back up when you start your first job..
I never read any of the textbooks in either program.. Graduated with straight A's from the LPN program at 29 years old with 2 kids 8 and 2. Cum laude from my BSN program with a minor in Poly Sci at 45 with teenagers..
Please don't sing to the choir.. Your previous post didn't seem like an opinion to me.. Stating that BSN's have more management skills than ADN's ..How many of either have you worked side by side????
WR,,, three commas for Becca
And you are right you don't have to be smart or even dedicated to graduate college..You just have to leave your common sense at the door...Just make sure to pick it back up when you start your first job..
I never read any of the textbooks in either program.. Graduated with straight A's from the LPN program at 29 years old with 2 kids 8 and 2. Cum laude from my BSN program with a minor in Poly Sci at 45 with teenagers..
Please don't sing to the choir.. Your previous post didn't seem like an opinion to me.. Stating that BSN's have more management skills than ADN's ..How many of either have you worked side by side????
WR,,, three commas for Becca
I don't think the organization skills have too much to do with any schooling I had myself. I think it came from life in general.
The day I gradutated my ADN program I was put in charge or the ortho/neuro unit where I had been a student extern for a year. (there was a RN in the stepdown for reference if needed) I was "in charge" of a LPN who had been there 20 years and was a semester behind me in school..that was a little joke. I went straight to work night shift RN on peds and the 2nd nurse was usually a LPN (one who is still a very good friend) who would do a little prompting but the organization came very quickly as we never got help. We might have 1 kid with a cold or 18 in traction it didn't matter it was us.
I also got a BSN and my management course was basically a joke. I sat in as the manager did 1 interview, she explained budget to me (ok by then I've been a nurse for a few years and married with 3 kids 9, 7 and 6 yrs old so I and I'm 29 years old and had been on own since I was 18 I think I can budget money) The manager of the unit to "teach" me something put me in charge of her units Joint Comm. project...big deal I did that on my job anyway as well as QI and policy committees. Then she being short staffed had to watch the monitors (cardiac step down unit)
So making my long story short. Life and work in general gave me organizational skills I don't believe it was school. I've always worked 30+ miles from work and never been late yet one nurse I work with who lives 3 blocks from the hospital is late everyday wonder why she can't get it together?
The day I gradutated my ADN program I was put in charge or the ortho/neuro unit where I had been a student extern for a year. (there was a RN in the stepdown for reference if needed) I was "in charge" of a LPN who had been there 20 years and was a semester behind me in school..that was a little joke. I went straight to work night shift RN on peds and the 2nd nurse was usually a LPN (one who is still a very good friend) who would do a little prompting but the organization came very quickly as we never got help. We might have 1 kid with a cold or 18 in traction it didn't matter it was us.
I also got a BSN and my management course was basically a joke. I sat in as the manager did 1 interview, she explained budget to me (ok by then I've been a nurse for a few years and married with 3 kids 9, 7 and 6 yrs old so I and I'm 29 years old and had been on own since I was 18 I think I can budget money) The manager of the unit to "teach" me something put me in charge of her units Joint Comm. project...big deal I did that on my job anyway as well as QI and policy committees. Then she being short staffed had to watch the monitors (cardiac step down unit)
So making my long story short. Life and work in general gave me organizational skills I don't believe it was school. I've always worked 30+ miles from work and never been late yet one nurse I work with who lives 3 blocks from the hospital is late everyday wonder why she can't get it together?
My big question here is if every one takes this Management course do they all learn the same things and get the same grades... If so nursing should be managed a whole lot better than it is right now..lol
WR,,, three commas for Becca
Remember "theories" never took care of a patient..
WR,,, three commas for Becca
Remember "theories" never took care of a patient..
if they did all take the same management course and learned it correctly then:
All managers should do evaluations the same
Schedules shouldn't be a problem no one night on one off one on one off
All those "bonus" tasks would always be done with inservices always on time.
no bickering between staff
everyone gets lunch on time
no favorites
can't we all just get along
All managers should do evaluations the same
Schedules shouldn't be a problem no one night on one off one on one off
All those "bonus" tasks would always be done with inservices always on time.
no bickering between staff
everyone gets lunch on time
no favorites
can't we all just get along
I do not see why floating to another floor is a problem. After all an ICU nurse is a nurse. Vitals, med administration is the same. Why would a nurse not want to help out a fellow nurse on a unit that is short and needs a hand. Maybe that is really what has happened to our profession, we have turned into a bunch of people who have a personal agenda. So sad
Let's make an analogy here.. A wife can cook a meal for her husband pretty easily. And she probably would love doing that being a good cook and all.. She could do this for 10 years maybe.. Always cooking for the two of them.. Then all of a sudden she has to cook for four families with two kids each. Now she has to cook for 16 people.. Big difference..
Have you read this whole thread. .I don't believe it's about nursing NOT helping each other it's about whether they are capable of helping. It's about quality of care. And I have seen a vent doesn't mean I can take care of that patient. Why would I expect a nurse who is used to taking care of 1-2 patients to be able to take care of 6-8.
When ICU nurses floated to our M/S floor they did tasks. Such as re copying MAR's, hanging some antibiotics, doing blood sugars. Please don't say we are all nurses. I can't do half or even one third of the specialities out there.
I probably couldn't even do M/S anymore even though I did it for 15 years.
WR,,, three commas for Becca
Many of the meds are different on a M/S floor as opposed to ICU.. Not many of the patients take P.O. meds in most ICU's..
Have you read this whole thread. .I don't believe it's about nursing NOT helping each other it's about whether they are capable of helping. It's about quality of care. And I have seen a vent doesn't mean I can take care of that patient. Why would I expect a nurse who is used to taking care of 1-2 patients to be able to take care of 6-8.
When ICU nurses floated to our M/S floor they did tasks. Such as re copying MAR's, hanging some antibiotics, doing blood sugars. Please don't say we are all nurses. I can't do half or even one third of the specialities out there.
I probably couldn't even do M/S anymore even though I did it for 15 years.
WR,,, three commas for Becca
Many of the meds are different on a M/S floor as opposed to ICU.. Not many of the patients take P.O. meds in most ICU's..
I bet M/S and ICU nurses don't mix much pit either or titrate the rate for a good contraction pattern.
I don't mind going to help on another unit (we just went closed July 1st) but the big complaint many nurses had when getting pulled is that they got the worst assignments..who knows if it was the worst or just seemed the worst since it's not something they are used to. If I'm in the hospital I'd prefer my nurse be the one who knows what's going on around them and knows my doc and what they want.
A nurse isn't a nurse isn't a nurse. Just like you can't say a teacher is a teacher. My physics teacher father couldn't teach my English teacher mother's comp class or vice versa. Commercial pilots might fly crop dusters but they are probably better in a big plane. Gee I could go on and on.
I don't mind going to help on another unit (we just went closed July 1st) but the big complaint many nurses had when getting pulled is that they got the worst assignments..who knows if it was the worst or just seemed the worst since it's not something they are used to. If I'm in the hospital I'd prefer my nurse be the one who knows what's going on around them and knows my doc and what they want.
A nurse isn't a nurse isn't a nurse. Just like you can't say a teacher is a teacher. My physics teacher father couldn't teach my English teacher mother's comp class or vice versa. Commercial pilots might fly crop dusters but they are probably better in a big plane. Gee I could go on and on.
Great analogies Cass. Thanks
WR,,, three commas for Becca
WR,,, three commas for Becca
When I was in ICU, we called it "floating" and I hated it. I got soooo burned out from the ACF that I transf. to Home Health.
An immediate supervisor responded to my question, when I was putting in for a transfer from a tele floor to the ED, why the particular hospital I was working for didn't pay more for critical area; "each person has their own perception of stress"; and the example she gave me was "would you be more or less stressed working in Rehab vs working in the ED?" Well, I love ED, and would hate Rehab, therefore if I had to go to a job I hated - that would give me alot of stress! Anyway, the point is, it would be stressful to float both directions, ie., ICU to floor vs Floor to ICU. This comment has helped me to understand other's stress from a floor that I wouldn't traditionally consider stressful. Capice?
My hospital is attempting to develop a policy re: being pulled to other units, generally it is the ICU and TCU nurses being pulled. When we are pulled to the ED we are assigned 2 rooms and have full responsibility for whatever patient may show up. I would like to see if other's have a policy or a general guideline,,,,,,,,,,thanks
Some places have policies that you must be trained to be pulled to 2-3 places. some places do not have policies, but just because a policy is not in place does not mean they can not allocate human resources to areas of need. If you are getting pulled to areas you do not feel trained, then you need to get trained. And request the training in writing. A good way is by email. It has a date/time stamp when sent.
One nice thing, here where I work you get $3.00 hr extra for pull pay if you are pulled to a department that is not like the one you work in. i.e. ICU to ER gets it. From one floor to another does not.
One nice thing, here where I work you get $3.00 hr extra for pull pay if you are pulled to a department that is not like the one you work in. i.e. ICU to ER gets it. From one floor to another does not.
Boy o boy, sombody opened up a can of worms here, didn't they. I'll put my two cents in for what it's worth.
I am an ICU nurse, have been for more years than I care to remember. But, I have also worked other floors as well...tele, m/s, ltc and even case mgmt for a short time. I don't like being floated to other floors, I am sure nobody does. I can understand for the "good of the hospital" and all that crap. My problem is they float our icu nurses and leave registry to work the unit because they can't find registry to work the floors. That is what aggravates most of the ICU nurses I work with.
I find it easy to identify the problem but can't seem to come up with a solution. Hire more nurses??? They just aren't out there. Pay more?? Not enough for me. I took the charge nurse position so I wouldn't have to float. It's true that going to the floors is like visiting another planet. I don't know where things are, I have trouble caring for 6 patients because I am so used to doing complete assessments q 1-2 hours and I just don't have that time luxury with 6 patients. I have tried in the past to reduce the time and care for 6 "more healthy" patients but I can't. I give all the credit to m/s and tele nurses. And, sad but true...we (ICU floats) do get the worst patients.
It comes down to the way we work. It is beating a dead horse I know, but previous posts about specialties and working other areas are correct. I could no longer deliver a baby and give pitocin than a l&d nurse could manage a balloon pump.
It doesn't make us bad nurses or uppity or anything...we are just ICU nurses and to make us float out of our comfort zone is just aking for trouble---for staff and for patients.
One more thought for the RN student in Michigan...All the classes in leadership and management aren't going to help when it comes right down to it. That other nurse was correct...either you have it or you don't. You just can't teach common sense. Oh, but I wish you could!!
I am an ICU nurse, have been for more years than I care to remember. But, I have also worked other floors as well...tele, m/s, ltc and even case mgmt for a short time. I don't like being floated to other floors, I am sure nobody does. I can understand for the "good of the hospital" and all that crap. My problem is they float our icu nurses and leave registry to work the unit because they can't find registry to work the floors. That is what aggravates most of the ICU nurses I work with.
I find it easy to identify the problem but can't seem to come up with a solution. Hire more nurses??? They just aren't out there. Pay more?? Not enough for me. I took the charge nurse position so I wouldn't have to float. It's true that going to the floors is like visiting another planet. I don't know where things are, I have trouble caring for 6 patients because I am so used to doing complete assessments q 1-2 hours and I just don't have that time luxury with 6 patients. I have tried in the past to reduce the time and care for 6 "more healthy" patients but I can't. I give all the credit to m/s and tele nurses. And, sad but true...we (ICU floats) do get the worst patients.
It comes down to the way we work. It is beating a dead horse I know, but previous posts about specialties and working other areas are correct. I could no longer deliver a baby and give pitocin than a l&d nurse could manage a balloon pump.
It doesn't make us bad nurses or uppity or anything...we are just ICU nurses and to make us float out of our comfort zone is just aking for trouble---for staff and for patients.
One more thought for the RN student in Michigan...All the classes in leadership and management aren't going to help when it comes right down to it. That other nurse was correct...either you have it or you don't. You just can't teach common sense. Oh, but I wish you could!!
I agree whole heartedly! As an ED and ICU nurse, the very thought of trying to accept a current Med/Surg assignment makes me shake with fear! Sure, I could do it, but certainly not to the level of comfort and expertise that a seasoned Med/Surg nurse could. We currently float our registry first-before any facility staff are floated. This is an important factor in "taking care of your own" first. As a new manager of a nursing registry, I fully support the premise that facilities should take care of their staff first and request from their agencies/registries the types of nurses they need. If an agency can't provide med/surg coverage, maybe the facility needs to look at a new agency! As to your final comment-I've been looking for the past 20+ years on how to teach common sense! I've always said that I'd rather have a diploma nurse who has common sense and "gut instinct" than a master's nurse who can write one heck of a research grant but can't decide if a patient is breathing or not.
Recently at our facility the ER nurses have been pulled to the floors and ICU. We are already under staffed, but it does not seem to matter. Even while I had 2 new orientees they pulled one of my seasoned nurses to ICU to relieve someone else. Of course this is all happening with overflow patients in the ER. It makes for some very interesting nights!
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. In fact, the thought of either specialty floating either place is down right scary. I'd be just as nervous about an ICU RN in M/S as I would in the opposite situation. However, the tele nurses and the M/S nurses do float between the two departments. Neither one likes to do this because it's outside the comfort zone. I do know that actually the float nurse tends to get the easier assignment with fewer admits because that will make their comfort level go up and they will require less assistance on an already busy unit. I have noticed that there is a definite territoriality among specialties. I have witnessed several instances in which critical care/ED RNs have insulted M/S RNs as "just a M/S nurse, so what do you know?". I have heard LDRP RNs say they work harder than any other department because of the volume of deliveries. I have heard Rehab nurses criticize Med/Surg nurses because they don't spend as much time doing psych-social support as the Rehab nurses do. I have seen M/S nurses criticize CC/ED nurses for lack of teaching skills or Rehab nursing for being "boring". I guess what I'm trying to say is that each and every area of nursing is a specialty. There is no "general" nursing. There is a definite skill set required of each, and floating in an emergency situation is to be expected, but should only occur with adequate support and resources. This nursing shortage will continue to stretch our creativity and resourcefulness to the limit and we need to work together with the patient as our center of focus. Whenever we are required to have a float RN in our unit, we assign a resource person to that nurse for reference and assistance, and they get the lower acuity assignment with less activity anticipated (admits, discharges, transfers, etc). There is still much grumbling on occasion, but thus far it has been a solution to an increasingly difficult staffing dilemma.
This happens on almost a daily basis . The problem is staffing will do anything to just staff the hospital . They don't care if someone works 8 -12 hour shifts in a row!! They will call anyone they can get to come in. If they get an ICU RN who will only work in ICU they will float another staff member. also they float a staff member to another department leaving ICU short staffed. This is happening more and more to us. I hate to float, but if we are overstaffed I understand , but not in the other two instances mentioned above.
I have seen units that dump the worst pts on the float nurse and it never made sense to me. Like biting the hand that feeds you, dumping on the person that comes to help.
I am an Ob nurse and I used to work a hospital where we would get pulled if census was low. Imagine a OB nurse getting pulled to Tele.. well it happened. For me it wasn't a big issue since I had worked tele in that hospital before switching to OB. But most of the nurses had never been anywhere but ob. The good thing was that the Tele nurses were good and would have us be med nurse or some other support position.
For the last 3 years I have been a nursing instructor in a ADN program. I think the MI nsg student should copy her posts and refer back to them in about 5 years from now.. be interesting to see how she feels then :) Nursing programs stress the correct and the optimal. Once you get out on the floor you face the real. The real is that you focus on what is needed to work your particular floor and the rest of the info fades, It can be revived yes but it isn't at your finger tips. The real is that knowing where things are on the unit and having the policies and procedures in your head double your efficiency..and not having it doubles your workload. The real is that no matter how much training you recieve, if you don't use it every day your brain is going to file it away under "Not Important"
I am an Ob nurse and I used to work a hospital where we would get pulled if census was low. Imagine a OB nurse getting pulled to Tele.. well it happened. For me it wasn't a big issue since I had worked tele in that hospital before switching to OB. But most of the nurses had never been anywhere but ob. The good thing was that the Tele nurses were good and would have us be med nurse or some other support position.
For the last 3 years I have been a nursing instructor in a ADN program. I think the MI nsg student should copy her posts and refer back to them in about 5 years from now.. be interesting to see how she feels then :) Nursing programs stress the correct and the optimal. Once you get out on the floor you face the real. The real is that you focus on what is needed to work your particular floor and the rest of the info fades, It can be revived yes but it isn't at your finger tips. The real is that knowing where things are on the unit and having the policies and procedures in your head double your efficiency..and not having it doubles your workload. The real is that no matter how much training you recieve, if you don't use it every day your brain is going to file it away under "Not Important"
Do floor nurses at your hospital get pulled to the ICU? To me this is one of the most blatant double standard in many hospitals. ICU nurses refuse to be pulled to the floor when their census is low and are given the option of staying at home or going home if they are already at work. Instead of sending the nurse home, why can't this nurse at least float to the floor to help out with admissions and stat orders? Now if a floor nurse refused to be pulled to the ICU, well that would be considered insubordination in many hospitals, and that nurse more than likely would be written up. Why do you think such a double standard exist?
Where my wife works, she can get pulled to the progressive care unit, or ER Holds, but that's it. She works in a union shop in New Jersey. They've tried pulling nurses to med/surg in the past and the ICU nurses wouldn't have it. Floating rules were written into the next contract and have been there ever since.
Two points for union representation there.
Andrew Lopez, RN
http://www.nursinga2z.com
Two points for union representation there.
Andrew Lopez, RN
http://www.nursinga2z.com
Hey, if you want to develop a policy stating that ICU nurses can not be pulled to the floor that is your choice. Do not expect the floor nurses to be pulled to the ICU unless they volunteer to go. It is only fair.
I worked the floor for 8 years before going to ICU. I can remember getting an ICU float and you'd have to hear them whine for the first 4 hours of the shift. They'd complain about being pulled off their unit and how taking 5 patients is much harder and blah, blah, blah.
Then I went to ICU. When we'd float, I'd hear the nurses whine about going and I thought, get over it already. But, after being there for 6 months, I started to see the picture. We would be down there bustin our butts, traiging pt's out to get the sicker ones in. And in the meantime, we're getting calls from the floors asking how to do this or that. I, myself, started to get irritated. We were busting our butts and who was helping us? Nobody. Nobody from ER came, nobody from anywhere came. Very frusterating. So, yeah, from that standpoint alone, floating to another unit from ICU sucks. And we do tend to get the crap assignments. We get the crazy guy in 4B that gets out of restraints, kicks and bites because everyone else is tired of having him. We also get the little lady in 2A that is incontinent and refuses a foley. We don't neccesarily get the "sickest" pt's but we get the ones that everyone else is tired of having. Which, usually means we're walking from one end of the hall to the other. Hourly meds and anything else they can think of. So yeah, I do have a problem with floating.
And being pulled to mothercare or pedi? Omg! Totally out of my element!
I don't mind helping other nurses, I really don't. But, it's hard to really want to go outside your unit when you know you're going to be crapped on ya know? Most nurse managers say that it doesn't happen, that we're not treated badly; they just don't know.
Anyhow, that's my take on it.
angee74
Then I went to ICU. When we'd float, I'd hear the nurses whine about going and I thought, get over it already. But, after being there for 6 months, I started to see the picture. We would be down there bustin our butts, traiging pt's out to get the sicker ones in. And in the meantime, we're getting calls from the floors asking how to do this or that. I, myself, started to get irritated. We were busting our butts and who was helping us? Nobody. Nobody from ER came, nobody from anywhere came. Very frusterating. So, yeah, from that standpoint alone, floating to another unit from ICU sucks. And we do tend to get the crap assignments. We get the crazy guy in 4B that gets out of restraints, kicks and bites because everyone else is tired of having him. We also get the little lady in 2A that is incontinent and refuses a foley. We don't neccesarily get the "sickest" pt's but we get the ones that everyone else is tired of having. Which, usually means we're walking from one end of the hall to the other. Hourly meds and anything else they can think of. So yeah, I do have a problem with floating.
And being pulled to mothercare or pedi? Omg! Totally out of my element!
I don't mind helping other nurses, I really don't. But, it's hard to really want to go outside your unit when you know you're going to be crapped on ya know? Most nurse managers say that it doesn't happen, that we're not treated badly; they just don't know.
Anyhow, that's my take on it.
angee74
I am also a unionized ICU nurse and floating is covered in my contract, which it should be. If I float, it is as a 'floater/helper' and I am NOT to be assigned patients. The only way an assignment can be given is if the nurse is crosstrained and fully oriented to the other unit, which is how it should work.
This floating stuff with full assignments is for the birds. From a LIABILITY standpoint alone, I would think a nurse to be a fool who accepted float assignments without adequate training/orientation.
The problem with so many nurses is they have LSE and compete. This issue is not about competition and 'who's better' it is about SAFE CARE.
Nurses need to grow some cajones and stand together and stop caving to the hospital's demands. They will not help you when you're sued for patient neglect...it will be all YOUR fault if you took an assignment you weren't qualified for.
Would you want a gastroenterologist doing your heart surgery? Of course not.
And no gastro would ever think of giving cardiac advice...from a LIABILIY and SAFETY standpoint. Those out there who thought we should all float without question, feel free to do it yourself; but I hope you have the number of a good malpractice attorney cuz you will likely need it.
This floating stuff with full assignments is for the birds. From a LIABILITY standpoint alone, I would think a nurse to be a fool who accepted float assignments without adequate training/orientation.
The problem with so many nurses is they have LSE and compete. This issue is not about competition and 'who's better' it is about SAFE CARE.
Nurses need to grow some cajones and stand together and stop caving to the hospital's demands. They will not help you when you're sued for patient neglect...it will be all YOUR fault if you took an assignment you weren't qualified for.
Would you want a gastroenterologist doing your heart surgery? Of course not.
And no gastro would ever think of giving cardiac advice...from a LIABILIY and SAFETY standpoint. Those out there who thought we should all float without question, feel free to do it yourself; but I hope you have the number of a good malpractice attorney cuz you will likely need it.
sasperger wrote: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
Anonymous wrote: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'
karmaloo wrote: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) ...
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.
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.
--------------------------------------------------------------------------------Nightstar,
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
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!
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!
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!
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.
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.
TomB wrote: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.My sentiments, exactly!
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.
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.
TomB wrote: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.:(
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 :)
I think we're all saying the same thing; each unit DOES have its discipline specialty and those nurses have mastered it. Expecting a nurse to float into another specialty area and function like a "regular" is unreasonable. As others have put it, working under such conditions is dangerous. In ancient nursing history or at least ten years ago, floating nursing staff onto other units experiencing staff shortages was a practical way to address a temporary situation. Often perdiem staff fit those short shifts better because they usually were acquainted with the unit. In reality, getting them when they were available was luck of the draw. Specialties weren't so well established then and those core nursing skills got you through the shift. This solution just doesn't work anymore and the practice should be stopped. I'm not sure what the solution to the problem is but I think that staffing to the maximal nurse/patient ratio as a norm leaves you one sick call away from a crisis. Let's be reasonable - and safe- and allow a bit of breathing space in the nurse/patient ratio. I don't think the floor would end up with nurses sitting around reading the paper. Everyone would still be busy, maybe a little less frantic and certainly the unit would be in a better position to work with unexpected staffing shortages. Any thoughts?
R
R
Ricu wrote:I think we're all saying the same thing; each unit DOES have its discipline specialty and those nurses have mastered it. Expecting a nurse to float into another specialty area and function like a "regular" is unreasonable. As others have put it, working under such conditions is dangerous. In ancient nursing history or at least ten years ago, floating nursing staff onto other units experiencing staff shortages was a practical way to address a temporary situation. Often perdiem staff fit those short shifts better because they usually were acquainted with the unit. In reality, getting them when they were available was luck of the draw. Specialties weren't so well established then and those core nursing skills got you through the shift. This solution just doesn't work anymore and the practice should be stopped. I'm not sure what the solution to the problem is but I think that staffing to the maximal nurse/patient ratio as a norm leaves you one sick call away from a crisis. Let's be reasonable - and safe- and allow a bit of breathing space in the nurse/patient ratio. I don't think the floor would end up with nurses sitting around reading the paper. Everyone would still be busy, maybe a little less frantic and certainly the unit would be in a better position to work with unexpected staffing shortages. Any thoughts?Your thought sounds good to me. :thumbsup:
R
I'm not surprised there are a lot of replies to this thread. This is one of those age old gripes. While I feel for the ICU nurse who is pulled to the floor, as a nursing director I have to look out for the good of the hospital and not just the ICU/PCU. Unless you work in a closed unit you should expect to be pulled to other units when census rises unexpectly or too many people call out, etc. Obviously, if you are being pulled to another floor often like weekly then admin needs to address this problem. I had a part time nurse who recently refused to float to the medical floors. I fired her the next morning. At the hospital I work for we determine where nurses are qualified to work and they can be floated where needed if they are qualified. I did my share of floating to other units over the years and I griped about it also but I went and did my best. I also agree that the medical charge nurse upon receiving a floater from ICU should realize they will probably not be operating at full eficiency. thanks for listening.
NavyJim58 wrote:I'm not surprised there are a lot of replies to this thread. This is one of those age old gripes. While I feel for the ICU nurse who is pulled to the floor, as a nursing director I have to look out for the good of the hospital and not just the ICU/PCU. Unless you work in a closed unit you should expect to be pulled to other units when census rises unexpectly or too many people call out, etc. Obviously, if you are being pulled to another floor often like weekly then admin needs to address this problem. I had a part time nurse who recently refused to float to the medical floors. I fired her the next morning. At the hospital I work for we determine where nurses are qualified to work and they can be floated where needed if they are qualified. I did my share of floating to other units over the years and I griped about it also but I went and did my best. I also agree that the medical charge nurse upon receiving a floater from ICU should realize they will probably not be operating at full eficiency. thanks for listening.What are your sentiments on a Med/Surg RN floating to an ICU?
Wow, you fired the nurse that refused to float? Where? Was this at a Military Medical Facility? I know if a civilian nurse in Texas feels their patients would be at risk D/T uncomfortable [to the extreme] w/floating to Med/Surg that they could call Safe Harbor. It is a very complicated process, so I won't go into the details here, but other TX RN's should be familiar with SH.
I realize as an ANC officer, Critical Care RN [8A] I'm required to float at MAMC. In fact, I have floated from ICU-E to ICU-W, which was no biggie. Often, we wil float to the Cardiac Stepdown Unit [2S] down the hall. Again, no biggie. In fact, when our ICU is at full capacity, and we are short staffed & have 2S over-flow patients sometimes a 2S nurse will float over to help us out. However, I seriously doubt a Med/Surg nurse will ever float down to our ICU? Then again, while I'm in Iraq the sky is the limit regards to nursing roles, LOL.
Wow, you fired that nurse, huh? Your a tough Admin... I should ask Aaron to keep you in mind for a Mod position here. :39:
May sound a bit stupid, but I always figured a ICU nurse would be able to work Med-Surg. 'a bit' easier than a Med-Surg nurse floating to ICU.
'Cat'
'Cat'
cougarnurse wrote:May sound a bit stupid, but I always figured a ICU nurse would be able to work Med-Surg. 'a bit' easier than a Med-Surg nurse floating to ICU.Nope, don't sound stupid to me at all. ;)
'Cat'
:houra:
Man... I love this discussion. What a diverse and expressive group we nurses are! I can readily see almost every side to the discussion. Keep posting!
Man... I love this discussion. What a diverse and expressive group we nurses are! I can readily see almost every side to the discussion. Keep posting!
justatraveler wrote:Frankly, monitors lie.:(With all due respect, monitors can be inaccurate, but they don't lie. Always, the first observation should be how the patient looks & acts, rather than what the monitor reads. However, if VS are needed Q 15 mins., including Swanz numbers, etc., then let us not ignore the advantages of modern science. ;)
nightstar3dp wrote: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!.The meds he mentioned are very common meds in the ICU. I have never met an ICU nurse who hasn't hung those meds. Most vented patients require diprivan or some other form of sedation, which can have the unfortunate side effect of dropping their blood pressure, thus the levophed. That isn't taking into account other issues contributing to the drop in BP such as sepsis among other things. Anyway, back to the point of the thread. I am a Neuro ICU nurse who has never worked a regular floor. I would feel completely out of my element. Thankfully, I have a union contract which states that ICU nurses can only be floated to other ICU's or Step-Downs. We also float our travel nurses before regular staff, that works in my favor since there are nights that I am the only regular staff RN on the unit.
Skipper_RN wrote:The meds he mentioned are very common meds in the ICU. I have never met an ICU nurse who hasn't hung those meds. Most vented patients require diprivan or some other form of sedation, which can have the unfortunate side effect of dropping their blood pressure, thus the levophed. That isn't taking into account other issues contributing to the drop in BP such as sepsis among other things. Anyway, back to the point of the thread. I am a Neuro ICU nurse who has never worked a regular floor. I would feel completely out of my element. Thankfully, I have a union contract which states that ICU nurses can only be floated to other ICU's or Step-Downs. We also float our travel nurses before regular staff, that works in my favor since there are nights that I am the only regular staff RN on the unit.Hey Skipper, I like your Union :thumbsup:
cougarnurse wrote:May sound a bit stupid, but I always figured a ICU nurse would be able to work Med-Surg. 'a bit' easier than a Med-Surg nurse floating to ICU.
'Cat'
This is where my opinion that new grads shouldn't hire into speciality positions comes in. Or at least new grads should have to do their practium hours (if those are required in your state) on a med/surg unit taking a full load to learn assessments, delegation, priority, time management etc. Then go to those speciality units to learn special things like critical pt management, speciality drugs and procedures and those blasted monitors. Then when you get pulled back to a general unit you have a good solid base to fall back to.
My problem with pulling to cover units (back in my pulling days) we had a rotation schedule but they (house supervisors) would say we want this one or that one to go because they can handle it and that one can't even if it is their turn...then it would turn into a thing of always wanting the same ones to go and nobody else would ever learn....it's also part of the mentality of give the pulled person the crappy assignment, ignore them, don't tell them when scheduled breaks/lunch are and make them hate to go to your unit.
As someone has said before when you have staff pulled to your unit you should welcome them for their help, offer to help them where you can, give them someone to go on breaks with, thank them for their help and make them not dread coming back...sounds like a good inservice to me :)
"As someone has said before when you have staff pulled to your unit you should welcome them for their help, offer to help them where you can, give them someone to go on breaks with, thank them for their help and make them not dread coming back...sounds like a good inservice to me." - cassioo
Sounds like team work to me. ;)
Sounds like team work to me. ;)
MagRedC5 wrote:
Sounds like team work to me. ;)
yep that's what it is:
don't eat your young
be nice to pulled people
don't ***** and moan all day or join in with those who do
don't be mean to the students but model for them so they grow up to be nurses you want to work with not the ones you hate to work with
if you get pulled ask if you don't know don't just not do things or ***** about it all day
I know little Mary Sunshine but it is true it get what you give and what goes around comes around.
Can't we all just get along???? I really should go to bed now
NavyJim58 wrote:I'm not surprised there are a lot of replies to this thread. This is one of those age old gripes. While I feel for the ICU nurse who is pulled to the floor, as a nursing director I have to look out for the good of the hospital and not just the ICU/PCU. Unless you work in a closed unit you should expect to be pulled to other units when census rises unexpectly or too many people call out, etc. Obviously, if you are being pulled to another floor often like weekly then admin needs to address this problem. I had a part time nurse who recently refused to float to the medical floors. I fired her the next morning. At the hospital I work for we determine where nurses are qualified to work and they can be floated where needed if they are qualified. I did my share of floating to other units over the years and I griped about it also but I went and did my best. I also agree that the medical charge nurse upon receiving a floater from ICU should realize they will probably not be operating at full eficiency. thanks for listening.
Just what I like- The good ole' " I did it so, you can do it too" thinking.
I've been around the block a few times and can say with confidence that it's a rare nurse who would refuse to take an assignment. While we don't know the details of this nurse's tenure, termination for refusal to float seems extreme. Maybe "admin" needs to look around.
Thanks for listening
R
justatraveler wrote:Frankly, monitors lie.:(
Yes they do! All the time. "Treat the patient, not the monitor."
But, part of the critical care skill set is learning to use monitors effectively as tools.
For example, vent alarms go off all the time. Do I look up every time a vent alarm goes off? Of course not. But, unconsiously, when the alarm keeps going off for about 10 seconds, you immediately go into the room without thinking about it.
There are many many things that can cause an alarm to go off when there's nothing wrong. But there are very few circumstances when an alarm doesn't go off when it should.
TomB wrote:Yes they do! All the time. "Treat the patient, not the monitor."
But, part of the critical care skill set is learning to use monitors effectively as tools.
For example, vent alarms go off all the time. Do I look up every time a vent alarm goes off? Of course not. But, unconsiously, when the alarm keeps going off for about 10 seconds, you immediately go into the room without thinking about it.
There are many many things that can cause an alarm to go off when there's nothing wrong. But there are very few circumstances when an alarm doesn't go off when it should.
I agree with much of what you say, but a monitor cannot lie any more than this computer I'm using can think. The information on a monitor is wholly dependent upon the input it receives from the patient. Monitors have not been given artificial intelligence yet, therefore they cannot lie, but they can give you an inaccurate graphical/numerical representation of the patient's condition.
The saying "Treat the patient, not the monitor" is advising a practitioner to not completely rely on the results of an electronic device which only shows an interpretation of exactly what information is put in it and is easily capable of being misread. If there is bad information going in, then it will give an unusable output. Therefore, it is most prudent to assess the patient prior to implementing any interventions based on a single source of possibly unreliable data. Never generalize from a single datum in any field of study, not just medicine or nursing.
Cammer wrote:I agree with much of what you say, but a monitor cannot lie any more than this computer I'm using can think. The information on a monitor is wholly dependent upon the input it receives from the patient. Monitors have not been given artificial intelligence yet, therefore they cannot lie, but they can give you an inaccurate graphical/numerical representation of the patient's condition.:thumbsup:
The saying "Treat the patient, not the monitor" is advising a practitioner to not completely rely on the results of an electronic device which only shows an interpretation of exactly what information is put in it and is easily capable of being misread. If there is bad information going in, then it will give an unusable output. Therefore, it is most prudent to assess the patient prior to implementing any interventions based on a single source of possibly unreliable data. Never generalize from a single datum in any field of study, not just medicine or nursing.
Hey! I'm an L&D nurse that got floated to PCU. I had 5 pts, had to look up EVERY med I gave, and gave 3 units of blood to an 85 yo woman. After the second unit was in, I noticed that she was coughing a little. Listened to her lungs, sounded wet. Told the charge nurse, who asked me how fast I was running the blood? 175cc/hr, at which she gasped and shouted "You can't run the blood that fast!!" But we do it all the time in L&D. Haven't ever had an 85 yo Mother in L&D. I was sick, literally. Cried all the way home that morning, and it took several months for me to regain my confidence. I work @ a hospital now that doesn't float. Thank God!! Because a nurse is NOT a nurse, is NOT a nurse. If that were true, PCU nurses would float to L&D.Kisses!!:)
I agree its horrible to be pulled to ICU if u are not trained because the training an ICU staff has is nothing compared to general nursing thats just my opinion.I had the opportunity of being trained in ICU for 2 months and that was an internal hospital programme not and official course.The stuff you take fro granted on regular medical and surgical floors is of the utmost importance in ICU.It was scary for the first week but i grooved in and it turned out ok.I never want to actually work there its a wee bit depressing and by the way where i worked was a 4 bed unit with no stepdown unit.
at the hospital that I work at we have 4 med/surg floors that are considered one closed unit which means you can be pulled to any one of those floors to work depending on staffing need. The labor/delivery floor is separately closed and the cvcu and icu is separately closed units which means that if you work on any one of those units you can't be pulled to another unit to meet staffing needs, they can ask you if you would work outside "your unit" but its your choice. Some nurses/aides dont mind working a med/surg shift for a change giving them a break from icu but some do mind, its their choice not the hospital supervisors. It sometimes is difficult for an icu nurse to work on a med/surg floor (rightly so) because they go from having 2 patients to about 7-8 patients and it screws with their time management skills. Especially if you've worked icu for many years, it takes some adjustment. Rachael LPN
I am a L&D nurse and have been for years. At my hospital when our census is down we get floated to other floors. We do not get a patient assignment because we have to be available to run back to our unit at a moments notice. When we float we do vitals, and generally help the nurses with whatever needs help. When they float to us they are with us the whole shift. We usually will have them do vitals and meds and answer call lights. We will still do the assessment because they are usually nervous about doingit, but if they want we are more than happy to teach them. We are so grateful to the nurses that come back to help us.
I have all the respect in the world for ICU nurses. I do not understand what thye do but they are good at it. I recently worked hand in hand with an ICU nurse to save a pregnant mother and she left me in absolute awe!!
many hospitals will still continue to float nurses, but if nurses respect each other and work together it should not be a horrible experience. It might even be a learning experience.
I have all the respect in the world for ICU nurses. I do not understand what thye do but they are good at it. I recently worked hand in hand with an ICU nurse to save a pregnant mother and she left me in absolute awe!!
many hospitals will still continue to float nurses, but if nurses respect each other and work together it should not be a horrible experience. It might even be a learning experience.
In my impression, this nurse expresses an appreciation for any help she can get regadless of the source. It speaks well of her and her colleagues to be grateful for whatever help they receive. What does it say for the rest of the hospital staff? Would you say they are ill prepared? I'm not sure what the best answer is here.
R
R
I had to read through all of these responses carefully. First of all, I'm a nurse on an extremely busy Orthopedic / Surgical floor. Having been a nurse for 17 years I'm not unfamiliar with really hard work but I can tell you that this position demands the very best of my skills, my knowledge, my ability to ask for help or clarification and so on. I am extremely fortunate, in that, our unit has a very strong core team of day nurses (TEAM being the most important part). We help each other!
My first response to the original post was "HMMMMMMPHHHH, You mean to tell me that the best, of the best, of the best are complaining when they are forced to come work with us. Give me a break".
However, upon thinking about it more, it would be hard for a nurse who's used to taking care of 1-2 patients (sometimes three?), to go to a floor where you have 4-8 patients. (For the record, I've never had 8 patients on my floor) What's doubly hard about that move is sometimes those 4-8 patients require nearly as much attention per patient as some I.C.U. patients (ok so it might not be the same sort of attention). The patients in I.C.U. are often so sick that they simply can't pose some of the difficulties that a floor patients care can. I.C.U. nurses also have less exposure to family members because of shortened visitor times. The I.C.U. at my hospital also seems to have alot more physician support.
It would be nice if none of us ever had to float but I say truthfully that I do not think this will EVER be a reality. Afterall, our job is to provide care to patients in need, not just patients in need on our unit.
The other issue in this is, as floor nurses we too, sometimes have to float to other floors. We don't like it much either. We don't know the routines, where the supplies are, who to go to, what some of the particular quirky Dr.'s quirks are and somehow we just trudge through.
The best thing we can do as a profession is treat one another with loving kindness and help one another. Be an example of this and maybe, just maybe someone will follow your lead.
My first response to the original post was "HMMMMMMPHHHH, You mean to tell me that the best, of the best, of the best are complaining when they are forced to come work with us. Give me a break".
However, upon thinking about it more, it would be hard for a nurse who's used to taking care of 1-2 patients (sometimes three?), to go to a floor where you have 4-8 patients. (For the record, I've never had 8 patients on my floor) What's doubly hard about that move is sometimes those 4-8 patients require nearly as much attention per patient as some I.C.U. patients (ok so it might not be the same sort of attention). The patients in I.C.U. are often so sick that they simply can't pose some of the difficulties that a floor patients care can. I.C.U. nurses also have less exposure to family members because of shortened visitor times. The I.C.U. at my hospital also seems to have alot more physician support.
It would be nice if none of us ever had to float but I say truthfully that I do not think this will EVER be a reality. Afterall, our job is to provide care to patients in need, not just patients in need on our unit.
The other issue in this is, as floor nurses we too, sometimes have to float to other floors. We don't like it much either. We don't know the routines, where the supplies are, who to go to, what some of the particular quirky Dr.'s quirks are and somehow we just trudge through.
The best thing we can do as a profession is treat one another with loving kindness and help one another. Be an example of this and maybe, just maybe someone will follow your lead.
singingtothewheat wrote:I had to read through all of these responses carefully. First of all, I'm a nurse on an extremely busy Orthopedic / Surgical floor. Having been a nurse for 17 years I'm not unfamiliar with really hard work but I can tell you that this position demands the very best of my skills, my knowledge, my ability to ask for help or clarification and so on. I am extremely fortunate, in that, our unit has a very strong core team of day nurses (TEAM being the most important part). We help each other!
My first response to the original post was "HMMMMMMPHHHH, You mean to tell me that the best, of the best, of the best are complaining when they are forced to come work with us. Give me a break".
However, upon thinking about it more, it would be hard for a nurse who's used to taking care of 1-2 patients (sometimes three?), to go to a floor where you have 4-8 patients. (For the record, I've never had 8 patients on my floor) What's doubly hard about that move is sometimes those 4-8 patients require nearly as much attention per patient as some I.C.U. patients (ok so it might not be the same sort of attention). The patients in I.C.U. are often so sick that they simply can't pose some of the difficulties that a floor patients care can. I.C.U. nurses also have less exposure to family members because of shortened visitor times. The I.C.U. at my hospital also seems to have alot more physician support.
It would be nice if none of us ever had to float but I say truthfully that I do not think this will EVER be a reality. Afterall, our job is to provide care to patients in need, not just patients in need on our unit.
The other issue in this is, as floor nurses we too, sometimes have to float to other floors. We don't like it much either. We don't know the routines, where the supplies are, who to go to, what some of the particular quirky Dr.'s quirks are and somehow we just trudge through.
The best thing we can do as a profession is treat one another with loving kindness and help one another. Be an example of this and maybe, just maybe someone will follow your lead.
Dear singing,
I agree with a lot of what you said but because I perceive a judgement against ICU nurses, feel as though your opinion is selective and exclusive. You admit to not having critical care experience but still feel qualified to make judgement against what you believe the workload is. You count patients where we count procedures, treatments, equipment, interventions, medications and the amount of time spent in them. You also grossly underestimate the degree of family interaction and the intensity with which this interaction takes place. Every ICU that I've worked in has unlimited visitation. Finally, you incorrectly assume that the presence of physicians in the unit means less responsibility for the nurse. Before you make another assumption, I HAVE worked med/surg/tele and OR, have had as many as ten patients in a shift, am no stranger to floating, so I do speak from experience. Workload is workload. It may look different depending on where you work but VERY few nurses sit around regardless of which unit OR which shift they work on.
Walk a mile in the shoes before judging the gait.
R
I don't think I ever said anything about nurses "sitting around." You did make a point though, work load is work load and we ALL get to share the triumphs as well as the low points. As I stated in my reply, I think it would be great if someone could figure out how to do away with floating entirely. I don't think that is going to happen though. Sorry if you were personally offended.
singingtothewheat wrote:I don't think I ever said anything about nurses "sitting around." You did make a point though, work load is work load and we ALL get to share the triumphs as well as the low points. As I stated in my reply, I think it would be great if someone could figure out how to do away with floating entirely. I don't think that is going to happen though. Sorry if you were personally offended.
No, the "sitting around" words were mine but it was the sense I got after reading several of your statements about ICU nursing responsibiltites; ICU patients are too sick so simply are not capable of creating the same challenges that surgical and/or orthopedic patients can, ICU assignments of two "or maybe three?" (let me add an exclamation point after the question mark,!) patients are the norm, your ICU seems to have more physician "support" and finally "the best of the best of the best" complains about working with us really went over the top. What does that mean? I wonder if you may not view ICU work as "simply potential" and not real, like yours. At one point you make statements about harmony among nurses and " let's support each other wherever we work," agree with my inference of work = work, but make critical and divisive comments about a certain branch of nursing, critical care. How do you really feel about your fellow nurses NOT working on your floor in your very strong CORE team? Specialization of nursing aside, your comments seem to come from a mindset which is less about floating but about inflexibility.
My offense as you put it is not really personal but professional.
R
Singing,
Let me apologize because I feel as though I'm coming down on you as an individual when really, the viewpoint(s) that you express are as I see them, common.
R
Let me apologize because I feel as though I'm coming down on you as an individual when really, the viewpoint(s) that you express are as I see them, common.
R
"Why is it a problem for ICU nurse to be pulled to general medical floors? I would see a problem if a med/surg nurse were pulled to work in the ICU. Granted, it is not an ideal situation to pull a nurse from one unit and float them to another. I guess I am just having trouble understanding the point of this particular thread."
Floating - Another age old problem that has no easy answer. My first 'feeling' when I read these posts is concern for the total lack of teamwork and respect for other nurses throughout the organizations that everyone works in. I think that is sad. Secondly, I agree floating is hard and not an easy or permanent solution. However, floating can work and be an effective to solution to staffing crunches during times when census is fluxuating through out the house.
We have tried to adopt a policy that ED and ICU nurses float to each of those units to help those respective units (closed coverage) unless someone volunteers to float somewhere else if census is low and they do not want to go home. Also we have people on the Med/Surg and Progressive Care floors sign-up to float to the ED for overflow patients to help the ED staff and take that burden off of them since that creates not only unsafe patient care practices but the ED nurses are not familiar with the inpatient paperwork and procedures. We are in a resort town and census is opposite for the ED and inpatient units.
It has worked out quite well. We have had more volunteers, because instead of getting 'bad' patient care assignments or dumped on the nurse that floats is basically an extra set of hands and does VS, finger-stick glucoses and that sort of thing; unless she or he has been competencied to work in that unit. The best part of the floating is the respect among staff...everyone is appreciative and treats that person well. Help is help....and we are all nurses. It beats the heck out of stuggling all shift!
Floating - Another age old problem that has no easy answer. My first 'feeling' when I read these posts is concern for the total lack of teamwork and respect for other nurses throughout the organizations that everyone works in. I think that is sad. Secondly, I agree floating is hard and not an easy or permanent solution. However, floating can work and be an effective to solution to staffing crunches during times when census is fluxuating through out the house.
We have tried to adopt a policy that ED and ICU nurses float to each of those units to help those respective units (closed coverage) unless someone volunteers to float somewhere else if census is low and they do not want to go home. Also we have people on the Med/Surg and Progressive Care floors sign-up to float to the ED for overflow patients to help the ED staff and take that burden off of them since that creates not only unsafe patient care practices but the ED nurses are not familiar with the inpatient paperwork and procedures. We are in a resort town and census is opposite for the ED and inpatient units.
It has worked out quite well. We have had more volunteers, because instead of getting 'bad' patient care assignments or dumped on the nurse that floats is basically an extra set of hands and does VS, finger-stick glucoses and that sort of thing; unless she or he has been competencied to work in that unit. The best part of the floating is the respect among staff...everyone is appreciative and treats that person well. Help is help....and we are all nurses. It beats the heck out of stuggling all shift!
"for the good of the HOSPITAL"
NavyJim58 wrote:I'm not surprised there are a lot of replies to this thread. This is one of those age old gripes. While I feel for the ICU nurse who is pulled to the floor, as a nursing director I have to look out for the good of the hospital and not just the ICU/PCU. Unless you work in a closed unit you should expect to be pulled to other units when census rises unexpectly or too many people call out, etc. Obviously, if you are being pulled to another floor often like weekly then admin needs to address this problem. I had a part time nurse who recently refused to float to the medical floors. I fired her the next morning. At the hospital I work for we determine where nurses are qualified to work and they can be floated where needed if they are qualified. I did my share of floating to other units over the years and I griped about it also but I went and did my best. I also agree that the medical charge nurse upon receiving a floater from ICU should realize they will probably not be operating at full eficiency. thanks for listening.
It is interesting to me, a CCU staff nurse, that you think the "good of the hospital' means floating Critical Care Nurses. You are, of course, referring to monetary "good". Cost effectiveness and the bottom line. Otherwise, you would surely have a float pool in place and not be stressing out your Critical Care nurses, which undeniably affects patient safety ANYWAY you look at it. You cannot possibly believe that stressing out Critical Care nurses by floating them is in the best interest of Patient Safety? Has it not been proven time and time again that nurse stress/burnout/staff patient ratios is DIRECTLY related to patient safety? If I worked for you I would unionize my fellow nurses and give them a voice. Hopefully you will never get sick and wind up in your own CCU. Shame on you for using and burning out critical care nurses this way!!! I realize I am only guessing, but I'll bet you felt very authoratative firing the poor part-time nurse, and I hope you had to pay her unemployment. Did that solve your bad moral in the Critical Care Units? My guess is you made it worse sir. Bad moral is STRESSFUL and increased nurse stress and burnout directly affects patient safety!! You are part of the problem in health care, sir. You are definately not Part of The Solution. Go to Iraq and take your scare tactics with you. By the way, does "not operating at full efficiency" refer to the CCU you short-staffed in order to make numbers on the Med-surge unit? Do you realize the SICKEST patients in the hospital are in the Critical Care Units? Do your Critical Care Nurses also handle codes and rapid responses? Shame on you for not appreciating them. What comes around goes around, and what will you do when it is your turn? Hospitals also "downsize" in management areas, also. Some hospitals want to be "Magnet" hospitals in which case they would empower nurses. Your turn is coming sir.
I think the problem is not just one of Cross training. It seems UNIVERSAL that it is the Med-Surge units affected with high turnovers and short staffing problems. It needs to be addressed and fixed. Patient/Staff ratios is the problem. Coupled with these are mainly new nurses who need positive support. NOT Negative, Punitive support which is often what happens. Fix that problem first, and you may not see a need for cross training. Nurse will Pick up overtime and come to work when they are treated fairly. Nurses are the Ultimate Patient Advocates, and I believe in them.
Amen Sister!! Also, when we are pulled to a med surge floor, the paperwork and routine orders are different, and we spend most of our valuable time looking for things. It is stressful, and stress leads to mistakes. That is a PROVEN fact!
You have a very sweet perspective, and I love your appreciation for the ICU nurse. When they float us, however, we are given an assignment. It is stressful for us in so many ways because we have a NEED to know Everything about the patient. It is impossible and we wind up feeling like a bad nurse. Stress leads to mistakes, we all know it. We also spend all day looking for things we usually have IN OUR ROOMS at our fingertips. We spin our wheels and try and make the best of it. But it creates bad morale and often short staffs us (some of the sickest patients in the hospital) to staff a med surge unit. It's ridiculous really.
You do have some valid points, Nurse DS. However, I see part of the nurse/Patient ratio as Management based: Money saving? Partially. Of course, now that we have so many unemployed/no health insurance....that is a big problem. People present when they are really sick.
I have seen some the 'older nurses' who look down on us younger ones, and try to 'break' us. Part of this is the new evidence based learning. Note, I said 'some' and 'part'. I have worked with some older nurses who could run RINGS around me, and taught me some really useful stuff. One thing is: try to make it a bit easier for the next shift. What comes around, goes around (unless they are just completely something else.)
BTW, my dad just got a bill.....$1000 for 3 months insurance. Bites, eh?
I have seen some the 'older nurses' who look down on us younger ones, and try to 'break' us. Part of this is the new evidence based learning. Note, I said 'some' and 'part'. I have worked with some older nurses who could run RINGS around me, and taught me some really useful stuff. One thing is: try to make it a bit easier for the next shift. What comes around, goes around (unless they are just completely something else.)
BTW, my dad just got a bill.....$1000 for 3 months insurance. Bites, eh?
Well then you shouldn't mind getting on a plane and flying to another state or anther country tomorrow to take care of patients who are in need. Please, do we really have to take care of all the patients in the world to believe we are great nurses? It is the UNIT MANAGER'S job to staff her unit.........not the Critical Care Nurses. I come in for my unit ON MY DAY OFF whenever I am needed, because I do CARE. But I don't imagine myself having to take care of all the patients in the world. Now that is just impossible and silly, isn't it? Unless you have a red cape with a big yellow "S" on it. That didn't come with my scrubs.
Yes it does, and there is another problem, whether or not to socialize medicine. I seen a show recently where medical staff was given raises depending on HOW their patients did. Keep their blood sugar under control? Keep their blood pressure under control? keep their cholesterol under control? I like that idea.
Nurse D.S. wrote:Yes it does, and there is another problem, whether or not to socialize medicine. I seen a show recently where medical staff was given raises depending on HOW their patients did. Keep their blood sugar under control? Keep their blood pressure under control? keep their cholesterol under control? I like that idea.
Don't you think some patients could be a bit more compliant? Like the 250 + one that has raging blood sugars, and 'just can't understand why they are so high', and they are stuffing their face with fattening, sugary food. You know the ones.
No offense, but you were not a Critical Care Nurse coming from and ICU with IABP's , Post OHS patients, Ventilated patients, etc. It is a different perspective for us.
I've worked in hospitals where all nurses float, even the critical care staff. Someone a few posts back indicated that we may as a sign of the times, be seeing more of this and I agree. In my current hospital, there's some floating going on in a lateral sort of way; med-surg units float across and critical units, ICU, ED, Cath Lab, PACU float across. We have seen Tele float to ICU and vice versa. The message here is that we're first nurses and as such, with some preparation, are able to handle this. That said, the receiving unit should be mindful when making up the assignment for the float nurse and the staff on that unit should be readily available to help when it's needed. If your focus is on good patient care and you treat "visiting nurses" well, you will be treated well when it's your turn to float.
R
R
Very thought provoking and interesting thread. We need more of these.
I am reminded of one time I asked to be the one pulled to ICU. This was a challenge and the nurses knew me and took that in consideration being I was an ER nurse. It all depends on the staff you are being pulled to help and your attitude when you arrive.
Do what you know how and ask for help with the others. Unfamiliar waters are scary and not wanting to be there is a jet set for anger and bitterness.
Moreover, I don't beleive one should be pulled unless to one of their "sister" department. Period.
I am reminded of one time I asked to be the one pulled to ICU. This was a challenge and the nurses knew me and took that in consideration being I was an ER nurse. It all depends on the staff you are being pulled to help and your attitude when you arrive.
Do what you know how and ask for help with the others. Unfamiliar waters are scary and not wanting to be there is a jet set for anger and bitterness.
Moreover, I don't beleive one should be pulled unless to one of their "sister" department. Period.
I have always seen it as we are nurses first, THEN specialize. Perhaps if 'the powers that be' would update EVERYone on what's going on in other Departments, it would help?
Sue, we are nurses first. However, my thought is for an example, if I am a Med/Surg nurse and pulled to labor and delivery I would be not only lost but a danger to my patients and my co-workers.
Basic nursing follow us, but, specific skills and procedures are learned through concept and experience.
I agree in part with your last inqury. Simply updating is not the only solution. It may help if a single nurse would be mandated, if you will, to be proficient in at least two areas if pulling is the answer to staffing issues. You think?
Basic nursing follow us, but, specific skills and procedures are learned through concept and experience.
I agree in part with your last inqury. Simply updating is not the only solution. It may help if a single nurse would be mandated, if you will, to be proficient in at least two areas if pulling is the answer to staffing issues. You think?
Grandma-RN wrote:Sue, we are nurses first. However, my thought is for an example, if I am a Med/Surg nurse and pulled to labor and delivery I would be not only lost but a danger to my patients and my co-workers.In retrospect; Med/Surg nurses don't float to ICU, now do they? ;-)
Basic nursing follow us, but, specific skills and procedures are learned through concept and experience.
I agree in part with your last inqury. Simply updating is not the only solution. It may help if a single nurse would be mandated, if you will, to be proficient in at least two areas if pulling is the answer to staffing issues. You think?
In otherwords, floating nurses out of their skill set & expertise is poor business practice. Sometimes we (STICU) float to Stepdown units but rarely to a regular med/surg floor.
Yes, it does happen. I have worked at a hospital that pulled Med/Surg nurses to not only ICU but to the ER. True facts.
How are you stranger. Good to see you!
How are you stranger. Good to see you!
Grandma-RN wrote:Yes, it does happen. I have worked at a hospital that pulled Med/Surg nurses to not only ICU but to the ER. True facts.
How are you stranger. Good to see you!
Seriously? Hate it when my 27 yo step-daughter says that, lol. Anyway...
Don't doubt you've seen such but at what level? BAMC (or SAMMC-N) is level 1 trauma. Therefore, our STICU (Surgical Trauma ICU) had state-of-the-art medical equipment along with critical patients. I'm not talking about MICU (Medical ICU), although don't mean to discredit same. I suppose a seasoned Med/Surg RN with ACLS, Tele experience, etc. could adapt his/her nursing skills in a float situation to ED & maybe ICU.
I've always admired Med/Surg nurses for their time mgmt skills, which involves much more than implies. Every healthcare member within the hospital setting is vital towards a positive patient outcome for discharge. However, for expert medical care on my shoulder I'd prefer an OrthoMD over General Surgeon. Same can be said about a loved one (or self) needing nursing care in the acute critical care environment.
I've been worse but certainly have been much better in the past compared to present. My L Shoulder, after 3 surgeries, has another RTC tear. I'm being looked at (not a quick process) by the Army for medical sep or med retirement d/t nondeployment r/t my recurrent/present L RTC tear.
It has been challenging re-acclimating to critical care setting (STICU) at BAMC... for several reasons; same but different from MAMC ICU, which was back 2007, since 07 done ICU detainee healthcare in Iraq, then 2yr Admin assignment (not Medical Center environment), and majority of staff I work with are cutthroats. BTW, our staff is maybe 60/40 civ/military and most of the friction is from the civ nurses, for whatever reasons.
Grandma, with all due respect---I should clarify my statement a bit. Yes, we are nurses; I understand your comment about Med-Surg nurses being pulled to L&D. I had meant the statement that ICU nurses would probably have an easier time on a regular floor in that they can 'sense' if something isn't 'quite right' or normal. True, the regular staff nurses have that 'sense' also, but.... I hope you understand a bit better where I am coming from.
SoldierNurse wrote:Seriously? Hate it when my 27 yo step-daughter says that, lol. Anyway...
Hehe...There are a few saying my children say that leaves me wondering what they mean. Hehe
Don't doubt you've seen such but at what level? BAMC (or SAMMC-N) is level 1 trauma. Therefore, our STICU (Surgical Trauma ICU) had state-of-the-art medical equipment along with critical patients. I'm not talking about MICU (Medical ICU), although don't mean to discredit same. I suppose a seasoned Med/Surg RN with ACLS, Tele experience, etc. could adapt his/her nursing skills in a float situation to ED & maybe ICU.
This particular hospital was a lever 3.
I've always admired Med/Surg nurses for their time mgmt skills, which involves much more than implies. Every healthcare member within the hospital setting is vital towards a positive patient outcome for discharge. However, for expert medical care on my shoulder I'd prefer an OrthoMD over General Surgeon. Same can be said about a loved one (or self) needing nursing care in the acute critical care environment.
I concur.
I've been worse but certainly have been much better in the past compared to present. My L Shoulder, after 3 surgeries, has another RTC tear. I'm being looked at (not a quick process) by the Army for medical sep or med retirement d/t nondeployment r/t my recurrent/present L RTC tear.
I do pray all be well, and of course, continued improvement.
It has been challenging re-acclimating to critical care setting (STICU) at BAMC... for several reasons; same but different from MAMC ICU, which was back 2007, since 07 done ICU detainee healthcare in Iraq, then 2yr Admin assignment (not Medical Center environment), and majority of staff I work with are cutthroats. BTW, our staff is maybe 60/40 civ/military and most of the friction is from the civ nurses, for whatever reasons.
What do you see as your biggest challenge since returning to the unit? I am curious; when a civillian works in a military hospital, are they able to be in management/charge nurse postion?
How is the grandbaby doing? talking.....yet?
@ GrandmaRN; D/T deployments & frequent PCS (assignment) changes we rely heavily on the civilian nursing staff at BAMC. Our STICU, as well as most others, have Assisitant Head Nurses that are civilians. We have a rotating charge nurse system where one person will be the same CN for 2-4 days in a row, then someone else follows suit. Our CNs can be either civilian or military. The one position I find different at a military hospital is the wardmaster slot. The wardmaster, always military NCO
(usually an LVN [68WM6] keeps track of all things related to military duties & task required of the military nursing staff. This person is also responsible for medical equipment inventory, and civilian work hours regards to pay, i. e. timesheets.
At BAMC we have Army, Air Force, civilian contract & GS staff, and lot's - lot's - lot's of medical/nursing/allied health/other military & civilian students. One thing good at BAMC is the nursing - MD working relationship, especially on the critical care units. It is like we are an extension of the teaching staff for the MD students. We (RNs) are required to take part in "rounds" for our patient and the HN & CN for the entire unit. We often make "implied suggestions" to the MD R/T our (healthcare team) patient care.
Hope that was not TMI :-)
(usually an LVN [68WM6] keeps track of all things related to military duties & task required of the military nursing staff. This person is also responsible for medical equipment inventory, and civilian work hours regards to pay, i. e. timesheets.
At BAMC we have Army, Air Force, civilian contract & GS staff, and lot's - lot's - lot's of medical/nursing/allied health/other military & civilian students. One thing good at BAMC is the nursing - MD working relationship, especially on the critical care units. It is like we are an extension of the teaching staff for the MD students. We (RNs) are required to take part in "rounds" for our patient and the HN & CN for the entire unit. We often make "implied suggestions" to the MD R/T our (healthcare team) patient care.
Hope that was not TMI :-)
No, not to much information at all. Thank you. I always wonder how it worked. Knowledge is wonderful and I love learning.
All right, where is my post to Sue. It stated, in part, that I kind of think we were say similar things, Sue.