Tuesday, February 24, 2009

2:1 nursing

Recently I’ve been the 2nd nurse for 2:1 patients a few times. These are patients whose care is so demanding that two nurses are needed to provide it all. They are usually unstable and on external devices to support their heart and/or kidney function.

In the most recent case, the patient was on ECMO which stands for Extra-Corporeal Membrane Oxygenation. On ECMO, the patient’s blood supply is routed out of the body via tubes inserted in the large arteries or more commonly veins in their groin to a device that oxygenates the blood before returning to the body. It’s used when a person’s lungs or heart-lung system isn’t working properly. Before ECMO was started on this patient, their supposed-to-be oxygenated arterial blood was black rather than the normal bright red. Post-ECMO insertion they were doing much better.

The workload for 2:1 patients is divided into inside and outside nurse. The outside nurse is more experienced and is the brains of the team. They made the clinical decisions and chart. The inside nurse is the hands of the team. They administer medications, adjust IV flow rates, draw blood for labs, suction the patient, etc.

It’s a show of confidence and respect that I’ve been assigned to be the inside nurse and let me tell you I was both proud and raring to prove myself worthy. Each time it’s worked out very well. It helps that I’m friendly with pretty much everyone at work and get along very well with the veteran nurses that often lead the 2:1 teams. It’s great experience and I look forward to doing it in the future.

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