A Nurse-Led QI Project to Reduce ED to ICU Transition Time

Countless studies conclude that the longer an admitted patient boards in an emergency department (ED) the greater the risk for negative outcomes such as falls and hospital-acquired conditions. ED patients waiting for admission to the intensive care unit (ICU) may be at the greatest risk, as they are categorized as critical.

Transporting critical patients from the ED to the ICU requires coordination of multiple clinicians from both units, which can lead to delays. Leading and managing these coordination efforts is a challenge. However we are optimistic as small tests of change have led us to advancements in the timeliness of ICU admissions and improvements in quality and safety.

-Jonathan Nover, MBA RN, senior director of nursing, Mount Sinai Queens

The Project

Geneline Barayuga, MSN RN

The ED and ICU teams at Mount Sinai Queens, a 165-bed hospital with 70,000 annual ED visits in Queens, New York, performed a quality improvement (QI) project by developing a collaborative approach between the ICU and ED charge nurses to reduce the median […]

2023-12-11T10:17:23-05:00December 11th, 2023|Nursing, Quality improvement|0 Comments

Making Sense of Loss, Finding Strength as a Nurse

Maria, day 6.

It was bright outside, the sun was shining, and as I looked at the window in Room 303, I saw the light peering through. Maria, a 78-year-old Hispanic woman, mother of three, could not move and did not see that spring had begun as she struggled to breath. She looked at me with her helpless teary eyes trying to communicate, but I could not hear the words.

I’d d been Maria’s primary nurse for five of the six days that she has been hospitalized. During that time, I had witnessed the tension and anxiety that existed within her family around her admission with Covid-19. I hoped silently that a DNR order would be initiated if her breathing worsened instead of her being placed on a ventilator. But I tried not to express my feelings to her family about this when I helped them to communicate with and see their mother using FaceTime.

Maria’s family watched as she slowly declined, and saw how she didn’t respond to treatments. Feeling hopeless and overwhelmed, I tried to schedule a time to speak to my nursing manager about how I was feeling, but she was always too busy scheduling and assisting on the floor after other staff called in sick.

Hard decisions […]

2021-05-13T10:24:41-04:00May 13th, 2021|COVID-19, Nursing|0 Comments

Hospital Visiting Policies in the Days of COVID-19

Last month, I watched a YouTube video with two physicians, ZdoggMD (Zubin Damania) and Vinay Prasad, both active on social media, discussing Prasad’s perspective that allowing patients “to die alone is a human rights violation.” He argued that clinicians should not accept blanket rules from administrators and believes there are ways around what seems to have been standard practice in hospitals during the COVID-19 pandemic.

So when we asked on AJN’s Facebook page (December 13), “Should hospitals allow patients with Covid-19 to have visitors?”, I was surprised that the comments were split. Many respondents supported the need for patients to be able to have loved ones with them, but many others felt visitors shouldn’t be allowed because PPE was scarce or because visitors didn’t follow rules and, as one commenter noted, “We don’t have time to be the PPE police.”

No one should die alone.

Nurses have been assisting patients to connect with family members by tablets or mobile phones, or in many cases filling in as surrogate family at the time of death. A colleague told me that in her ICU, nurses decided no one would die alone and made sure that one member of the staff was there with the patient. And while this was comforting to many families, I know from a […]

Levels of Weariness Among Nurses

I imagine that nurses throughout the world are constantly being asked “How are things at work these days?”—with the implied question being “How are you holding up with your work situation?” While my colleagues and I in our pediatric hospital have not seen an overwhelming surge of COVID+ patients come through our doors, we have certainly seen some, with an uptick in our COVID+ census as the numbers throughout the country have increased.

When I pause at this point in the conversation, the usual response I get is, “Oh, that’s so good to hear. You’re lucky.” And I agree and reflect this back to whoever I’m speaking with. My heart hurts for my fellow nurses in other parts of the nation who have been utterly overwhelmed by COVID and its cruelty. I recognize that I am indescribably lucky.

At the same time, though it’s hard to articulate why, even nurses who haven’t been hit by the surges seen in other hospitals bear layers of deep weariness by this point in the pandemic. […]

Every Frontline has a Backline: What Nursing Can Learn from Rugby

Photo credit: KJ Feury

Have you ever had a day at work that could only be fixed by an ice cream from your favorite creamery or by a hug from your best friend? Every shift during the height of the COVID-19 pandemic felt like this.

Unfortunately, because I work as an RN in a pediatric ICU at a large hospital in northern New Jersey, social restrictions that coincide with COVID-19 forestalled my usual comfort measures. After the start of the COVID-19 pandemic and during my reassignment in the COVID-19 ICU, I could no longer truly “leave” work. Work came home and walked with me throughout my day.

Dozens of IV pumps lining hallways, countless boxes of gowns, gloves, masks, and rubber shoes scattering the unit; ventilator alarms sounding; coworkers with surgical caps and masks, only identifiable by their eyes. The once medical–surgical unit transformed into a critical care unit equipped to care for COVID-19 patients.

After donning and doffing personal protective equipment (PPE), giving medication, adjusting ventilators, and updating families, you leave your 12+ hour shift wondering if you did your best. In the chaos of an unfamiliar unit, caring for patients with an unfamiliar virus, did I do everything to create the best outcome for my […]

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