silversteak.... okay so your tone has changed from "i make the decisions in the ICU that keep patients alive" to "i have pre-set orders on what I can or can't do" to actually believing that following orders implies that you are assuming the role of decision maker in critical care...
i have no problem w/ experienced nurses following algorithms and protocols - i do have a problem when somebody without any medical training comes on to this board and starts stating that an experienced ICU nurse is the savior...
i quote from Silverstreak: "As far as ICU experience, the average trend is 2-3 years ICU experience in the usual SRNA class. Years of experience can range from 1 year to over 10 years in any given class. Many are quick to downplay that experience. When that sick septic patient rolls in the door and the intensivist is in route, I'm the one hanging drips, getting labs, and getting the ball rolling before he even gets there without any back up from him. It is imperative that I understand what's going on, what the current recommended treatments are, and how to intervene fast. Granted, he will usually intubate when he gets there and place a line, but I've learned to work with what I've got and keep that patient going until he gets there. Same goes for the bypass patient who is bleeding. I call the surgeon to come in, but the management of that patient is left up to me until he gets there. It's a huge responsibility when you've got that patient crashing depending on you until the surgeon gets there to fix the problem. I'm only a bandaid in the interim, but if I don't respond appropriately, aggresively, and in an emergent manner, it won't matter because the patient will die before the surgeon gets there. "
Just to clarify, when I say no back up from him, yes we have sepsis standing orders, so he expects that I've got levophed going, I've ordered all the labs, cultured everything, giving fluid boluses, I don't wait on him to do any of this, but with a protocol it was very poorly worded on my part that I don't have any back up at all, it is an easy phrase to misinterpret.
And, when I say we work with what we've got until he gets there, they usually come from the ER with a peripheral on NC looking like crap, so we typically don't have much to work with until the doc gets there, but we do a pretty good job usually with what we do have.
When I say management of the patient is left up to me, I am controling the gtts keeping a pressure, running my blood in, just trying to keep the patient as stable as possible until the surgeon gets there to go back to the OR. It is not a fun place to be for anyone, but the surgeon can't be two places at once, and I can't be at the patient's bedside taking care of what I can if I'm on the phone with him the whole time. We have a system, it may be different from what others use, but it works very well in our units.
I showed this post to my wife (who is an ICU nurse) and she laughed at how delusional you are.... obviously if you are such an astute clinician you can open your own ICU....
when you actually make it through CRNA school you will look back on your postings and understand how ludicrous you sound
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