Responsibilities in Critical Care Job

[cabrom]

I wanted to find out from other PA's who work in SICU or MICU, what are your responsiblities/patient load? I have been working in a MICU for 6 months. I have at this point worked my way up to being responsible for 4-5 patients and am doing most of everything they require; labs/studies/meds/consults/notes/transfers/etc..this includes all of us doing interdisciplinary rounding....I work an 8 hour shift. Even though it doesn't sound like a large patient load...I'm very busy the whole day. I would like to know from others how you are utilized in your role in the ICU...if the same as me or responsible for more patients, or help out with everyone but not assigned fully to one patient...etc. I am wanting to figure out a goal to work up to that is reasonable. I don't want to compromise patient quality of care to get my numbers up, just want to know on average what is the norm. I am the only midlevel in the ICU. Thank you.

[crieman]

I typically see anywhere from 12-20 in both MICU and SICU. Responsible for everything but have back up after hours with intensivist on call. I work 12's and the intensivist has office and floor patients so sometimes they are in the ICU for an hour, sometimes 8 hours. As far as procedures it depends on the comfort level of the PA but we are all expected to be proficient in at least CVC, and I do a lot. Other common procedures include intubation, chest tubes, thoracentesis and assisting docs with perc trachs. I love my job.

[andersenpa]

I've worked a few different critical care jobs, all surgical. Census and acuity varies and as you know, 5 patients can be busier than 20 dependeing on level of illness etc. So its hard to pick a "goal" but rather shoot for being as efficient as possible in everything!

 

The workload also depends on involvement of the attendings. As your get more experience (and that is recognized), you will need less and less.

 

Currently in CTS, and on my ICU days, I usually meet with the surgeons after they finish their OR. I have the whole morning/afternoon to get things taken care of and just give a report of the days events. If I call a surgeon it's because I coded the pt or they may need to go back to the OR (which fortunately is infrequent!)

 

Procedures are mainly lines/CTs/thoracentesis/IABPs.

 

 

CCM is a great field for PAs and if you can do the work you will always be able to find a job somewhere....

[familygal]

I work in a cancer-only institution. Our ICU has 54 beds (yes, 54). We have a group of 10 midlevels who rotate though our MICU, SICU, and one who does triage of new patients and sees the few neuro patients if we have any. We work 14 hour days, 3 days per week, and rotate one MLP each weekend (so I do a weekend about once every 2 months). Get time off during the following week if we work the weekend. Its a great schedule.

 

In MI and SI, we could have up to 13 patients on our own team, but most days we've got an extra MLP "float" to help out with the census. Residents help us out on the SI side, but we are depended on more than they are, as they're not staff here. We are an open ICU. With regards to our duties, we basically do everything you mentioned, except we don't do transfer orders (the primary teams do that), we don't dictate any H&Ps, admit or d/c notes. We are not required to write daily notes either, as our physicians do the billing, so they write the note.

 

We start our days at 5:10 am and a.m. rounds start at 8:30 with attendings, MLP, PharmDs, RNs, RTs, etc. Its formally-organized. We are expected to have pretty much all the patient information on every patient at that time, having examined the patient, have a plan for each patient, and present each patient. AMs are very busy, and it was a tough learning curve; we had quite the turnover of MLPs who couldn't keep up. After rounds, which usually last until 10am-noon, we follow up on test, consults, procedures, etc. We do a lot of central lines (incl. dialysis lines) and art lines. Not a lot of intubations, but have done some, and I've done some bronchs with certain attendings. Our afternoons slow down. Then I leave and have 4 days off :-)

[familygal]

I work in a cancer-only institution. Our ICU has 54 beds (yes, 54). We have a group of 10 midlevels who rotate though our MICU, SICU, and one who does triage of new patients and sees the few neuro patients if we have any. We work 14 hour days, 3 days per week, and rotate one MLP each weekend (so I do a weekend about once every 2 months). Get time off during the following week if we work the weekend. Its a great schedule.

 

In MI and SI, we could have up to 13 patients on our own team, but most days we've got an extra MLP "float" to help out with the census. Residents help us out on the SI side, but we are depended on more than they are, as they're not staff here. We are an open ICU. With regards to our duties, we basically do everything you mentioned, except we don't do transfer orders (the primary teams do that), we don't dictate any H&Ps, admit or d/c notes. We are not required to write daily notes either, as our physicians do the billing, so they write the note.

 

We start our days at 5:10 am and a.m. rounds start at 8:30 with attendings, MLP, PharmDs, RNs, RTs, etc. Its formally-organized. We are expected to have pretty much all the patient information on every patient at that time, having examined the patient, have a plan for each patient, and present each patient. AMs are very busy, and it was a tough learning curve; we had quite the turnover of MLPs who couldn't keep up. After rounds, which usually last until 10am-noon, we follow up on test, consults, procedures, etc. We do a lot of central lines (incl. dialysis lines) and art lines. Not a lot of intubations, but have done some, and I've done some bronchs with certain attendings. Our afternoons slow down. Then I leave and have 4 days off :-)

[familygal]

I work in a cancer-only institution. Our ICU has 54 beds (yes, 54). We have a group of 10 midlevels who rotate though our MICU, SICU, and one who does triage of new patients and sees the few neuro patients if we have any. We work 14 hour days, 3 days per week, and rotate one MLP each weekend (so I do a weekend about once every 2 months). Get time off during the following week if we work the weekend. Its a great schedule.

 

In MI and SI, we could have up to 13 patients on our own team, but most days we've got an extra MLP "float" to help out with the census. Residents help us out on the SI side, but we are depended on more than they are, as they're not staff here. We are an open ICU. With regards to our duties, we basically do everything you mentioned, except we don't do transfer orders (the primary teams do that), we don't dictate any H&Ps, admit or d/c notes. We are not required to write daily notes either, as our physicians do the billing, so they write the note.

 

We start our days at 5:10 am and a.m. rounds start at 8:30 with attendings, MLP, PharmDs, RNs, RTs, etc. Its formally-organized. We are expected to have pretty much all the patient information on every patient at that time, having examined the patient, have a plan for each patient, and present each patient. AMs are very busy, and it was a tough learning curve; we had quite the turnover of MLPs who couldn't keep up. After rounds, which usually last until 10am-noon, we follow up on test, consults, procedures, etc. We do a lot of central lines (incl. dialysis lines) and art lines. Not a lot of intubations, but have done some, and I've done some bronchs with certain attendings. Our afternoons slow down. Then I leave and have 4 days off :-)

[coloradopa]

We have more than 70 PAs and NPs across 8 ICUs. We have a number of different models depending on the resident involvement. Each ICU is staffed separately with some on fixed schedules (days and nights) and some on rotating schedules. We also have some cross cover for gaps in the schedule. Our SICU has 20 beds with high turnover. The beds are generally split with residents handling 12 patients and the PA handling 8. We are responsible for the patients we have including pretty much everything that the OP mentioned. The attending rounds with the residents and does teaching between 830 and 1200. Then we have lunch and round on the PA patients. That usually lasts around 1 1/2 to 2 hours. Before rounds we are expected to do any procedures and manage the patient. We have the attending and usually a fellow if there are any questions. During the week there is an NP that rounds with the residents and can break away to handle emergencies. On the weekend we leave any empty beds on the PA service so we can take admits. We also end up doing lines on resident patients when its something that they don't do much like vascaths.

 

The amount of patients that you should be able to take depends on your experience and acuity. In our ICU which has a very high acuity one patient can frequently dominate 3 or 4 hours of your time leaving little time for other patients. Even when all the patients are "stably critically ill" sometimes you are hard pushed to get everything done in a thirteen hour shift. For most people I think that 4-5 is reasonable for 8 hours. On the other hand when I go to the other SICU in our sister hospital which is community based and has much lower acuity, I can finish 8 patients in 5-6 hours.

 

The other issue that we struggle with is billing. We are expected to use at least 75% of our time in patient care. If you are very busy documenting the care so you can bill becomes a limiting factor. We have noticed that billing actually goes up as we add more people. Its probably a combination of spending more time on each patient which allows you to make breakpoints in time based billing as well as having time to actually document everything that you do. When I was at SCCM one attending talked about covering a 25 bed SICU at night by himself. He did almost no billing since he never had time to document anything while putting out fires all night. For most ICUs with relatively high acuity, I think the sweet spot is around 6-8 patients for a 12 hour shift.

[coloradopa]

We have more than 70 PAs and NPs across 8 ICUs. We have a number of different models depending on the resident involvement. Each ICU is staffed separately with some on fixed schedules (days and nights) and some on rotating schedules. We also have some cross cover for gaps in the schedule. Our SICU has 20 beds with high turnover. The beds are generally split with residents handling 12 patients and the PA handling 8. We are responsible for the patients we have including pretty much everything that the OP mentioned. The attending rounds with the residents and does teaching between 830 and 1200. Then we have lunch and round on the PA patients. That usually lasts around 1 1/2 to 2 hours. Before rounds we are expected to do any procedures and manage the patient. We have the attending and usually a fellow if there are any questions. During the week there is an NP that rounds with the residents and can break away to handle emergencies. On the weekend we leave any empty beds on the PA service so we can take admits. We also end up doing lines on resident patients when its something that they don't do much like vascaths.

 

The amount of patients that you should be able to take depends on your experience and acuity. In our ICU which has a very high acuity one patient can frequently dominate 3 or 4 hours of your time leaving little time for other patients. Even when all the patients are "stably critically ill" sometimes you are hard pushed to get everything done in a thirteen hour shift. For most people I think that 4-5 is reasonable for 8 hours. On the other hand when I go to the other SICU in our sister hospital which is community based and has much lower acuity, I can finish 8 patients in 5-6 hours.

 

The other issue that we struggle with is billing. We are expected to use at least 75% of our time in patient care. If you are very busy documenting the care so you can bill becomes a limiting factor. We have noticed that billing actually goes up as we add more people. Its probably a combination of spending more time on each patient which allows you to make breakpoints in time based billing as well as having time to actually document everything that you do. When I was at SCCM one attending talked about covering a 25 bed SICU at night by himself. He did almost no billing since he never had time to document anything while putting out fires all night. For most ICUs with relatively high acuity, I think the sweet spot is around 6-8 patients for a 12 hour shift.

[coloradopa]

We have more than 70 PAs and NPs across 8 ICUs. We have a number of different models depending on the resident involvement. Each ICU is staffed separately with some on fixed schedules (days and nights) and some on rotating schedules. We also have some cross cover for gaps in the schedule. Our SICU has 20 beds with high turnover. The beds are generally split with residents handling 12 patients and the PA handling 8. We are responsible for the patients we have including pretty much everything that the OP mentioned. The attending rounds with the residents and does teaching between 830 and 1200. Then we have lunch and round on the PA patients. That usually lasts around 1 1/2 to 2 hours. Before rounds we are expected to do any procedures and manage the patient. We have the attending and usually a fellow if there are any questions. During the week there is an NP that rounds with the residents and can break away to handle emergencies. On the weekend we leave any empty beds on the PA service so we can take admits. We also end up doing lines on resident patients when its something that they don't do much like vascaths.

 

The amount of patients that you should be able to take depends on your experience and acuity. In our ICU which has a very high acuity one patient can frequently dominate 3 or 4 hours of your time leaving little time for other patients. Even when all the patients are "stably critically ill" sometimes you are hard pushed to get everything done in a thirteen hour shift. For most people I think that 4-5 is reasonable for 8 hours. On the other hand when I go to the other SICU in our sister hospital which is community based and has much lower acuity, I can finish 8 patients in 5-6 hours.

 

The other issue that we struggle with is billing. We are expected to use at least 75% of our time in patient care. If you are very busy documenting the care so you can bill becomes a limiting factor. We have noticed that billing actually goes up as we add more people. Its probably a combination of spending more time on each patient which allows you to make breakpoints in time based billing as well as having time to actually document everything that you do. When I was at SCCM one attending talked about covering a 25 bed SICU at night by himself. He did almost no billing since he never had time to document anything while putting out fires all night. For most ICUs with relatively high acuity, I think the sweet spot is around 6-8 patients for a 12 hour shift.