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- Apr 20, 2012
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Hey Everyone,
For starters, I'm not entirely sure what a good forum for this would be so I ended up here.
I'm in the process of switching jobs, and I'll soon (hopefully) be working in a hospital environment which is fairly new to me. I'm still on the newer side of things, but I've worked in a major tertiary care centers and a small community hospital, but the new place is a small-medium sized trauma center, with a community residency program (IM and GenSurg). I'm particularly interested in input from a Resident's POV - but then again every attending was a resident at one point, so all advice is appreciated.
New Hospitals Background:
-Level II Trauma Center
-ICU is semi-open. PulmCC takes all medical patients, along with the Interns and Residents on ICU rotation. Trauma takes all surgical patients along with the GenSurg Residents (I'm not quite sure how Trauma ends up managing other surgical services patients, but there it is).
-The ICU is shared between the teams, as there's only one big unit and not separate ones.
-For a "community" center, the patient acuity I've noticed is fairly high.
-Paper charting. Yeah really.
The RT's:
-Responsible for intubations on the wards (codes and RRT's) and NICU/Peds. Anesthesia usually comes to intubate in the ICU, but typically gives the Residents first crack at it. RT also shares certain vascular access duties (A-lines and CVC's) with the physicians. Once inserted RT does all the "maintenance", as well as all the monitoring of invasive hemodynamic lines.
-There are no protocols or standard procedures (for both nursing and RT). No SBT or weaning protocols, no pulmonary hygiene, nada. Everything must be specifically ordered by the physician (which obviously means many pages to the physician).
Given the work environment (paper charting, no protocols) I want to ensure that I'm always providing the team with as much information as possible, but at the same time I don't want to be hammer-paging some poor doctor 24 times a shift with endless bull****. I'm used to working with strong protocols, so calling the doctors for everything will be an adjustment, and honestly I just don't want to be a pain in the ass about it. Since there is no EMR (making it harder to constantly stay current on patient information), I also want to make sure I'm doing the job well enough that I'm hopefully saving the physicians from undo worry, at least on my behalf. But mostly, given the uniqueness of this environment, I really just want to ensure I'm doing a good job.
So, in your experience what makes a good RT?
-What do you wish the RT's knew about your particular patient population?
-What information in the ICU setting do you want your RT's to present or have ready for you? How about on the Wards, where we don't see each other as often?
-How much detail do you want about vent settings and lung mechanics - and how much is too much?
-Are you ever comfortable writing orders for specific ranges (i.e. titrate pressure support for VT >6ml/Kg, titrate O2 for SpO2 >92%, etc.), if you are, what's usually a good place to start when asking?
And pretty much anything else you can think of - don't be shy, lay it all out there!
For starters, I'm not entirely sure what a good forum for this would be so I ended up here.
I'm in the process of switching jobs, and I'll soon (hopefully) be working in a hospital environment which is fairly new to me. I'm still on the newer side of things, but I've worked in a major tertiary care centers and a small community hospital, but the new place is a small-medium sized trauma center, with a community residency program (IM and GenSurg). I'm particularly interested in input from a Resident's POV - but then again every attending was a resident at one point, so all advice is appreciated.
New Hospitals Background:
-Level II Trauma Center
-ICU is semi-open. PulmCC takes all medical patients, along with the Interns and Residents on ICU rotation. Trauma takes all surgical patients along with the GenSurg Residents (I'm not quite sure how Trauma ends up managing other surgical services patients, but there it is).
-The ICU is shared between the teams, as there's only one big unit and not separate ones.
-For a "community" center, the patient acuity I've noticed is fairly high.
-Paper charting. Yeah really.
The RT's:
-Responsible for intubations on the wards (codes and RRT's) and NICU/Peds. Anesthesia usually comes to intubate in the ICU, but typically gives the Residents first crack at it. RT also shares certain vascular access duties (A-lines and CVC's) with the physicians. Once inserted RT does all the "maintenance", as well as all the monitoring of invasive hemodynamic lines.
-There are no protocols or standard procedures (for both nursing and RT). No SBT or weaning protocols, no pulmonary hygiene, nada. Everything must be specifically ordered by the physician (which obviously means many pages to the physician).
Given the work environment (paper charting, no protocols) I want to ensure that I'm always providing the team with as much information as possible, but at the same time I don't want to be hammer-paging some poor doctor 24 times a shift with endless bull****. I'm used to working with strong protocols, so calling the doctors for everything will be an adjustment, and honestly I just don't want to be a pain in the ass about it. Since there is no EMR (making it harder to constantly stay current on patient information), I also want to make sure I'm doing the job well enough that I'm hopefully saving the physicians from undo worry, at least on my behalf. But mostly, given the uniqueness of this environment, I really just want to ensure I'm doing a good job.
So, in your experience what makes a good RT?
-What do you wish the RT's knew about your particular patient population?
-What information in the ICU setting do you want your RT's to present or have ready for you? How about on the Wards, where we don't see each other as often?
-How much detail do you want about vent settings and lung mechanics - and how much is too much?
-Are you ever comfortable writing orders for specific ranges (i.e. titrate pressure support for VT >6ml/Kg, titrate O2 for SpO2 >92%, etc.), if you are, what's usually a good place to start when asking?
And pretty much anything else you can think of - don't be shy, lay it all out there!
