Start Date: 10/09/2022

End Date: 01/07/2023

Status: Open

Total Positions: 2

Skill: RN Critical Care

Duration: 13 - Weeks

Location: NY - St. Peter's Hospital

Shift Start Time: 07:00:00

Shift End Time: 19:30:00

Description:
Type of Patients Served
ICU is a 19-bed unit serving acutely or critically ill patients. Services provided include inpatient comprehensive care to patients in need of intensive treatment and monitoring that cannot be provided outside of the ICU. The patient focused care model is utilized with the majority of patients remaining on ICU from admission to transfer to a less acute level of care and/or discharge.

Ages of Patients Served
The ICU serves primarily the adult and geriatric populations.

Current Services for Patients and Patients’ Families:

Frequent Procedures, Processes, Services
• Cardiac Monitoring
• Pulmonary Artery (PA) Catheter insertion and monitoring
• Arterial line and Central Venous Pressure (CVP) monitoring
• Therapeutic Hypothermia
• Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis
• Mechanical ventilation
• Transvenous pacing/external pacing
• Continuous Renal Replacement Therapy (CRRT)
• Administration of high risk medications.
• Hemodynamically unstable patients requiring hemodialysis or peritoneal dialysis
• Ventriculostomy & Lumbar drain monitoring & management

Scope and Complexity of Patient’s Care Needs

ICU serves as a place for monitoring and care of patients with symptomatic disease processes that are potentially severe, physiologically unstable, and require technical and/or artificial life support. Patient care needs can cover a range from simple medication and treatments to the complex intensive monitoring of unstable patients. Intensive monitoring may include ventilator support, invasive hemodynamic monitoring, and/or active continuous titration of vasoactive medication.

Criteria for Entry to Services
Diagnosis Model: This model uses specific conditions or diseases to determine appropriateness of ICU admission.
A. Cardiac System
1. Acute Myocardial infarction with complications
2. Cardiogenic Shock
3. Complex arrhythmia’s requiring close monitoring and intervention
4. Acute congestive heart failure with respiratory failure and/or requiring hemodynamic support
5. Hypertensive emergencies
6. S/P cardiac arrest
7. Cardiac tamponade or constriction with hemodynamic instability
8. Dissecting aortic aneurysms
9. Complete heart block

B. Pulmonary System
1. Acute respiratory failure requiring ventilatory support
2. Pulmonary emboli with hemodynamic instability
3. Patients in an intermediate care unit who are demonstrating respiratory deterioration
4. Need for nursing/respiratory care not available in lesser care areas such as floor or intermediate care unit
5. Massive hemoptysis
6. Respiratory failure with imminent intubation

C. Neurologic Disorders
1. Acute stroke with altered mental status
2. Coma: metabolic, toxic, or anoxic
3. Intra cranial hemorrhage with potential for herniation
4. Acute subarachnoid hemorrhage
5. Meningitis with altered mental status or respiratory compromise
6. Central nervous system or neuromuscular disorders with deteriorating neurological or pulmonary function
7. Status epilepticus
8. Brain dead or potentially brain dead patients who are being aggressively managed while determining organ donation status
9. Vasospasm
10. Severe head injured patients
11. Patients requiring intracranial pressure monitoring.
12. Patients with lumbar drains.

D. Drug Ingestion and Drug Overdose
1. Hemodynamically unstable drug ingestion
2. Drug ingestion with significantly altered mental status with inadequate airway protection
3. Seizures following drug ingestion

E. Gastrointestinal Disorders
1. Life threatening gastrointestinal bleeding including hypotension, angina, continued bleeding, or with comorbid conditions
2. Fulminate hepatic failure
3. Severe pancreatitis
4. Esophageal perforation with or without mediastinitis

F. Endocrine
1. Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis
2. Thyroid storm or myxedema coma with hemodynamic instability
3. Hyperosmolar state with coma and/or hemodynamic instability
4. Other endocrine problems such as adrenal crisis with hemodynamic instability
5. Severe hypercalcemia with altered mental status, requiring hemodynamic monitoring
6. Hypo or hypernatremia with seizures, altered mental status
7. Hypo or hyper magnesium with hemodynamic compromise or dysrhythmias
8. Hypo or hyperkalemia with dysrhythmias or muscular weakness
9. Hypophosphatemia with muscular weakness

G. Surgical
1. Surgical patients requiring hemodynamic monitoring/ventilatory support or extensive nursing care

H. Miscellaneous
1. Septic shock with hemodynamic instability
2. Hemodynamic monitoring
3. Clinical conditions requiring ICU level nursing care
4. Environmental injuries (lightning, near drowning, hypo/hyperthermia)
5. New/experimental therapies with potential for complications

The ICU intensivist will make the ultimate decision as to the appropriateness of admission.

Conflicting problems in treatment and/or management regarding patients and/or policies of the unit will be referred to the Chief of Critical Care, who will have the final decision.

Hours of Operation- ICU is operational 24 hours a day, seven days a week.

Methods Used to Assess Patient/Patient Population Care Needs

Processes:
Evidence based assessment tools (i.e. pain, sedation, etc.) will be utilized in the assessment and evaluation of patient care needs. An individualized plan of care will be implemented upon admission and continuously updated to meet changes in the patient’s condition.

Methods Used to Determine Extent to Which Patient Needs are Met and Services Adjusted

Services:
Care will be provided to patients and patient families that include physiological, psychological, spiritual, and social needs in a collaborative team approach.

Staffing

Budgeted
Optimal staffing is achieved by established staffing patterns, which provide an optimum number of hours of care per patient day.

Minimum
A staffing plan is developed to include the number and mix of staff, provide a minimum number of hours of care per patient day to meet anticipated needs of the patient.


Qualifications of Staff

A. Registered Nurse
• Current Basic Life Support
• Successful completion of unit specific orientation and Cardiac/Critical Care course (within 6 months of hire).
• Advanced Cardiac Life Support (within 6 months of hire)
• Annual Cardiac and Critical Care Competency Validation
• Continuous Renal Replacement Therapy (CRRT), and Therapeutic Hypothermia classes and competency evaluation.
B. Respiratory Therapist:
• Current Basic Life Support
• Successful completion of Core Orientation
C. Patient Care Associates
• Successful completion of orientation program
• Current Basic Life Support
• Annual Competency Validation
D. Information Associate:
• Successful completion of the orientation program

Methods used to adjust staffing
Staffing in ICU will be adjusted every 4 hours, and prior to end or beginning of shift based on changes in the census and/or acuity. It will be the responsibilities of the charge RN to determine the appropriate changes, calling on the Nurse Manager/ Supervisor for assistance.

Goals of Department/Unit
• Provide quality patient care.
• Maintain a collaborative multi-disciplinary approach to care utilizing the pa