In Defense of On-the-Job Learning in the ICU

Image via Wikimedia Commons

By Marcy Phipps, RN, who is a regular contributor to this blog. She emphasizes that the identity of the impatient practitioner described in this post has been altered in significant ways to prevent any chance of recognition.

“This is why new nurses have no place in critical care!” said the trauma physician. “I’m sure she’s a fine nurse, but she should be getting experience with these situations on the floor!”

The issue of whether new nurses should work in critical care comes up from time to time. It seems to polarize people, and it always touches a nerve with me. I was hired directly into the ICU upon passing the boards, as were many of the nurses I work with. My hospital offers a program to new graduates that includes training and education specific to critical care and an extended clinical experience with a preceptor. Admittedly, there is a steep learning curve, but I wouldn’t consider it unsafe—and comments that suggest the contrary irritate me, because they undermine new nurses and foster negativity.

This patient probably would have pulled his PEG tube out no matter how experienced his nurse was, and I’m not sure the step-down floor would have been a “better” place for a new nurse to manage that situation. The patient acuity is lower on the floor, but there are also fewer nurses around to help out, and a […]

2016-11-21T13:11:33-05:00November 2nd, 2011|career, Nursing|6 Comments
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Giving Noise a Red Light

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

This stoplight noise meter showed up at the nurse’s station last week.

I have to admit—we didn’t take it too seriously, at first.

It looks like something you could buy in a novelty shop, shelved next to lava lamps and strobe lights. And it’s modifiable; buttons and dials on the back of the gadget allow not only for sensitivity adjustments, but also give the option of changing the type of alarm that sounds when a noise infraction is detected. The default alarm warning is a soft-spoken, female “quiet, please!” that can be translated into Spanish, French, or German—but there’s also an option for a shrill siren, which seems ridiculous, considering that much of the cacophony of critical care is owed to noisy alarms and ringing phones.

We even discovered how to record our own admonishments (which opened the door to countless mischievous possibilities . . . not that we’d indulge in that sort of thing, of course).

In seriousness, noise reduction is vital to promoting a healing environment. In a recent article in Critical Care Nurse, the links between sleep deprivation and altered physiologic processes specific to the critical care population are reviewed. Noise reduction guidelines and recommendations from […]

2016-11-21T13:12:28-05:00July 8th, 2011|Nursing, nursing perspective, patient experience|2 Comments
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Swimming from Alcatraz

by jitze couperus via Flickr

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

I’m going to swim from Alcatraz.

It’s daunting, yet irresistible, and a challenge I’m not taking lightly. As part of my preparation, I’ve purchased the book Open Water Swimming: Lessons from Alcatraz. In it, Joe Oakes and Gary Emich deliver a wealth of information and practical advice in a very direct way. They’ve provided much to mull over during my long training swims—and I’ve been struck by how well the principles they stress can be applied to nursing:

“Never swim alone and always swim with a competent pilot.”

It would obviously be unwise to attempt a treacherous swim alone. Similarly, it’s vital to work with a team who can be trusted to back one another up. It’s also vital to know who the resource people are and to have a mentor, whether formally or informally.

“There are plenty of sharks in San Francisco Bay.”

Unfortunately, there are occasionally sharks amongst hospital staff, as well. Shark-like behavior should be identified for what it is, and handled accordingly. It should never be taken personally.

“Wet suits are the most obvious way to keep yourself insulated.”

The […]

2016-11-21T13:13:23-05:00April 25th, 2011|career, nursing perspective, personal health practices|6 Comments
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What Lies Ahead? AACN Presidents Weigh In on Health Care Reform, Rapid Response Teams, and More

By Shawn Kennedy, AJN interim editor-in-chief

On my last day at the American Association of Critical-Care Nurses’ annual meeting last week in Washington, DC, I had a chance to speak with both Beth Hammer, whose term as president ended with the meeting, and Kristine Peterson, the new president. Our conversation ranged from how they felt about being president of such a large nursing organization to their views on health care reform and how rapid response teams are affecting the work environment of critical care nurses. You can hear the conversation free on AJN’s Web site: go to the Podcasts tab and click on Conversations. Or just click here (the download may take a minute or two).

And don’t miss my first post from the exhibit hall floor at the meeting (the National Teaching Institute & Critical Care Exposition, or “the NTI”)  and my second post on a conversation with a critical care nurse about a bad staffing practice, which seems to have hit a nerve!

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2016-11-21T13:17:31-05:00May 24th, 2010|career, health care policy, nursing perspective|0 Comments
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Thousands of Critical Care Nurses, a Helicopter, and More! AACN’s National Teaching Institute & Critical Care Exposition

By Shawn Kennedy, AJN interim editor-in-chief

 

I’m writing to you this morning from Washington, DC, where I’m attending the American Association of Critical-Care Nurses (AACN) 2010 National Teaching Institute & Critical Care Exposition (known simply as “the NTI”). I’m probably miscounting, but I think this might be my 15th visit to the NTI. I first attended when I was an ED staff nurse at Bellevue Hospital in New York City. I marveled at the hundreds of nurses who attended from all across the country. It was energizing and inspiring and overwhelming, and I learned a lot.

Now, it’s not just hundreds but thousands of nurses who attend the NTI, and they come not only from states across this country but also from around the globe. It’s still energizing, and there’s no doubt I can still learn a lot. Throngs of nurses have crowded the sessions, so much so that it’s hard to remember there’s a nursing shortage; but critical care nurses are still much in demand, and representatives from many hospitals—as well as from all branches of the military—are manning recruitment booths. The exhibit hall is still overwhelming: this year there are more than 500 exhibitors and the exhibits include a Life Flight helicopter, a couple of full-size buses equipped as classrooms or EDs, and a fully-equipped military emergency treatment tent.

I’ve attended some very good sessions and a couple of clunkers—a better ratio than I’ve found […]

2016-11-21T13:17:39-05:00May 19th, 2010|Nursing|1 Comment
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