Sunday, April 18, 2010

First ICU overnight

I walk up to the ICU, coffee in hand. It's a little before 7:00 p.m., I've never been in the unit this late. Volume in the hospital appears to be at an all-time low, as I walk past empty room and nursing stations. I turn the corner and see a cluster of nurses huddled around the schedule.

"Do you want to float to MHU*?" One of the nurses asks me.
"This is my first overnight in the ICU. I don't know who my preceptor is tonight, but it might be good to stay here so I can see the routine."
We discuss this a little longer, and eventually come to the conclusion that I should go to the MHU with whichever aide is floating there, so that if I have to float there by myself I'll be familiar with their unit.

Jen arrives. She's worked as an aide for something like at least five years, first on the med-surg floor and then in the ICU. She told me went to nursing school for her RN, but was working some insane amount of hours concurrently, had some bad-influence slacker boyfriend and generally wasn't too serious about school. She flunked out. She's now doing an LPN program, in hopes that her improved grades will give her the groundwork for continuing for her RN. I was sort of surprised. She seems smart. It seems like she's learned a lot by osmosis, which is part of what I love about the ICU.

We've been assigned to float to MHU together. She's clearly irked about this (not her favorite unit). When we get there, I find out that we've been assigned to do a 1:1 observation on a patient who is planning to commit suicide that night by tearing up her bed sheets. Looks like it'll be a 2:1. One of the psych techs gives me a clipboard with a log. We sit down near her, and every 15 minutes, record what she is doing.

The psych tech comes back, asks me if I want anything to read. I ask if I can read one of their medical journals that I saw in their nursing area. Turns out that it belongs to one of the physicians and I'm not supposed to read it. This seems totally backwards to me! Mental note: when I'm a doctor, I will make an effort to share my journals with curious staff. The psych tech ends up bringing me one of her own magazines, Women's Health, and I read an interview with Pink (the musician). She's gone through the magazine and highlighted sections. I can't decide whether I should be awed by her thoroughness, or baffled as to why she is memorizing health information from a popular magazine. Maybe she has loaned it to many others, and someone else has gone crazy with the highlighter.

Eventually someone asks if I want to "round" on the patients. There are only about 12 in the adult unit, so I memorize their names (lots of patients have pulled off their wristbands). I walk around the unit and write down what each patient is doing at 15 or 30 minute intervals (depending on the patient). I had no idea that they document this 24 hours a day.

11:00p.m. Our four hours of float time is up.** We walk back to the ICU. Now that it's over, I can say it was quiet. Three beds were occupied in a sixteen-bed unit. Two of the patients were on ventilators. I have never seen never seen it that empty.

This gives me plenty of time to stock. It seems like the task of stocking supplies in the ICU is endless. We stock the med room (not medications -- that's the pharmacy's job, but other supplies); linens in the rooms; syringes, needles, ABG kits, tubing, and about four different sized bags of saline in each room's locked drawers; supplies in the cabinets: yankauer tips and tubing, suction liners, 4x4s, 2x2s, abdominal dressing pads, chlorapreps, tegaderms, biopatches, emesis basins, tape, hygiene supplies (no-rinse soap, shampoo, shaving cream, razors, toothbrushes, toothpaste, combs, lotion, barrier ointment, deodorant, perineal area spray cleanser). The list goes on and on. It was good. There are definitely supplies in the ICU that I'm not familiar with. We also periodically restock procedure carts (and crash carts -- including a Broselow!) which have cool stuff -- intubation supplies, temporary pacemakers, central line kits, etc. Stocking and finding stuff in our clean utility room took up the better part of the night.

The remainder was uneventful: vital signs every two hours, running EKG strips, fingersticks, blood draws, emptying and replacing the suction liners and tubing, and baths for the patients on vents. During one bath, I saw some complicated patient with a seriously edematous scrotum (the size of a cantaloupe). He had pretty bad edema in his hands, legs and feet, too. I guess places without musculature to squeeze fluid back into the body get hit hard. I felt really bad for him. At least he was sedated.

*Mental Health Unit
*Do people float at your hospital? One facility about 30 minutes away from us has a "float team." They hire nurses specifically for the float team, and they never have a home unit. I have no idea what happens when volume is down in the hospital.

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