ICU- Primary

General Description of Position:

• The primary job responsibility of the emergency room nurse is to ensure rapid and thorough care is provided to all pets presenting to the emergency service. Primarily, this will entail performing diagnostics and treatments on emergency patients. This nurse would also be responsible for some owner communications, assisting the doctors directly with record keeping and procedures. One emergency nurse will be assigned to be the primary triage nurse each day.

Essential Functions:

• Report to work
• Must be an experienced veterinary technician. CVT or other licensing is preferred but not required. Desire to pursue VTS specialty certification is a plus and encouraged.
• Good communication skills with coworkers and clients
• Able to draw blood, place IVC, and run blood work
• Knows how to take x-rays/proper positioning
• Able to sedate patients and monitor while under sedation
• Can lift and restrain up to 40 lbs.
• Can monitor anesthesia
• Knows basic math calculations for medications

Triage

• This is to be performed as outlined in the protocol: rapid assessment and vitals performed upstairs unless patient stability/demeanor precludes this, very brief history, and transport of unstable patients downstairs
  • This requires recognizing when these vital signs are abnormal based on type of patient, age and disease process
• All patients are then written on the triage board
  • Doctors will assign themselves when they are ready to see the case
• One emergency nurse per day is assigned to this as their primary role
• If there are no patients currently requiring triage, other emergency room duties should be completed
  • Special attention to daily tasks such as checking crash cart, callback bin, etc.

Treatment of Emergency patients

• Ensuring all prescribed treatments are completed within the ordered time period
• Taking/monitoring vital signs/blood pressures, etc. Recognizing when these vital signs are abnormal based on type of patient, age, and disease process, and reporting these to the doctor.
Giving medications/IV fluids in all routes of administration-oral meds/injectable meds
• - subcutaneous/intramuscular/intravenous. Consulting protocol book or prescribing doctor for instruction of administration of unfamiliar drugs
• Establishing intravenous catheters along with IV fluids. Following IV catheter care protocols and fluid protocols to ensure patient safety
• Drawing blood for laboratory tests and then performing in house Chemistry/CBC/Lytes/Snap Tests/Urinalysis and SediVue/Crossmatch/Blood typing/set up certain assays/tests/biopsy/cultures/cytology etc. to be sent out to Idexx. Maintaining responsibility for in-house tests and diluting appropriately when results are out of range
• Practicing safe handling and maintenance of patient tubes including but not limited to chest tube, nasal oxygen, urinary catheters, abdominal drains. Following prescribed orders for timed drainage/technique/dosage
• Be able to safely prepare blood transfusions as per protocol. Be able to calculate an appropriate starting rate and increase rate as indicated. Be able to monitor appropriately and recognize when vital signs are abnormal, as well as report to the doctor

Admitting patients

• Creating estimates and reviewing them with clients
• Completing admission treatments and diagnostics as ordered by the veterinarian
• Rounding ICU nurses when the patient is transferred to their care, following nurses rounds format

Other Patient Care

• Compassionately, calmly and gently approaching and handling patients. Practice Fear Free techniques whenever possible
• Approaching and handling patients according to safety protocols and core values.
• Practicing basic animal husbandry – ensuring clean/dry bedding, clean litter boxes at all times. Ensuring all patients have water available unless specifically under order not to. Following prescribed diet orders, as well as recording amount offered, amount eaten, and adverse reactions
  • Checking patients prior to discharge – clean, dry, etc.
• Practicing critical thinking and independent thinking. Be aware of what tasks are most critical to be performed and doing those first (pain medication, insulin, temperature checks on a patient on heat, etc). Be aware of what types of care you usually give to patients and question if this is not being ordered (such as pain medicine in a fracture, anti-nausea medications in a vomiting patient). Notice and alert the doctor if there are other concerns regarding a patient (has not urinated since admission, no appetite, painful, straining to defecate, etc.)

Record Keeping

• Assisting emergency doctor by beginning SOAPs
  • Enter weight, vitals, and presenting complaint
• Entry of the vital signs and medications given to each patient into the computer and writing them down onto each patients treatment sheet which holds all orders pertaining to that patient that is overseen by the doctor in charge of the case
• Entering radiology request forms
• Making sure all charges are appropriately entered with specific amounts recorded
• Ensuring that eliminations are recorded on the treatment sheet and electronic record. Ensuring the doctor is informed if there is an abnormality
• Reviewing euthanasia paperwork with client if this cannot be completed by doctor or front desk

Care of the ER

• Cleaning of the ER to meet infection control guidelines. Delegating cleaning tasks to assistants as necessary. This includes but is not limited to daily cleaning/disinfection of patient housing, surface cleaning/disinfection in the ER, mopping, sink cleaning/disinfection
• Aid in maintaining/properly using equipment within the hospital including, but not limited to oxygen cage, anesthesia machines, clippers, blood pressure/SP02 and resp. monitors, syringe/IV pumps
  • Checking and cleaning anesthesia machines
• Organizing the working area
• Ensuring needed items are in stock and delegating restocking to assistants as necessary.
• Checking the crash cart once a shift and filling out the checklist
  • Restocking or replacing missing items immediately

Procedural Support

• Aid in the intubation/sedation/anesthetizing of patients as needed
• Restraining patients for procedures/exams for doctors
• Performing CPR
• Filling medications to go home
• Reviewing discharge paperwork with client if this cannot be completed by the doctor
• Check the callback bin for lab work/x-ray results and get them to the appropriate doctor
• Calling primary care veterinarian for records/radiographs if Stella is unavailable
• Actively participate in hospital’s day to day function by taking on additional responsibilities as needed.
• Answer phones- they ring constantly; “Thank you for calling Central hospital for Veterinary Medicine, this is _______________ how may/can I help you?”

Work Environment:

• Clean and well organized ICU and treatment area
• Easily accessible medical equipment and supplies
• Noisy conditions can occur
• Protective equipment for nervous animals is easily accessible

ER- Secondary

General Description of Position:

• The ICU nurse is responsible for the care and monitoring of all patients hospitalized in the ICU, with the exception of the patients cared for by the critical care nurse. This includes administration of medications, performing procedures such as blood draws, and assisting doctors in procedures. Nurses are expected to treat patients with compassionate and gentle handling and use Fear Free techniques as much as possible. The ICU nurse is also expected to recognize abnormal vital signs, pathology in the patient, and practice critical thinking regarding the patient. Nurses are responsible for entering nursing updates into the electronic medical record whenever treatments are performed. Nurses are expected to participate in cleaning of the ICU to maintain basic infection control and to give owners periodic brief updates when the doctors are unable to. Finally, nurses are responsible for preparing rounds notes and adequately informing the next shift of all pertinent patient information.

Essential Functions:

• Report to work at scheduled time
• Must be an experienced veterinary technician. CVT or other licensing is preferred but not required. Desire to pursue VTS specialty certification is a plus, and encouraged.
• Good communication skills with coworkers and clients
• Able to draw blood, place IVC, and run bloodwork
• Knows how to take x-rays/proper positioning
• Able to sedate patients and monitor while under sedation
• Can lift and restrain up to 40lbs
• Can monitor anesthesia
• Knows basic math calculations for medications
• Can work efficiently and multitask

Administration of Treatments

• Ensuring all prescribed treatments are completed within the ordered time period
• Taking/monitoring vital signs/blood pressures, etc. Recognizing when these vital signs are abnormal based on type of patient, age, and disease process, and reporting these to the doctor
Giving medications/IV fluids in all routes of administration- oral meds/injectable meds
• - subcutaneous/intramuscular/intravenous. Consulting protocol book or prescribing doctor for instruction of administration of unfamiliar drugs
• Establishing intravenous catheters along with IV fluids. Following IV catheter care protocols and fluid protocols to ensure patient safety
• Drawing blood for laboratory tests and then performing in house Chemistry/CBC/Lytes/Snap Tests/Urinalysis and SediVue/Crossmatch/Blood typing/set up certain assays/tests/biopsy/Cultures/Cytology etc to be sent out to Idexx. Maintaining responsibility for in house tests and diluting appropriately when results are out of range
• Practicing safe handling and maintenance of patient tubes including but not limited to chest tube, nasal oxygen, urinary catheters, abdominal drains. Following prescribed orders for timed drainage/technique/dosage
• Tube feeding – esophageal, naso-esophageal, nasogastric, and gastric tubes. Being able to reconstitute/blenderize diets as prescribed and administer through the tube
• Be able to safely prepare blood transfusions as per protocol. Be able to calculate an appropriate starting rate and increase rate as indicated. Be able to monitor appropriately and recognize when vital signs are abnormal, as well as report to the doctor

Other Patient Care

• Compassionately, calmly and gently approaching and handling patients. Practice Fear Free techniques whenever possible
• Approaching and handling patients according to safety protocols and core values
• Practicing basic animal husbandry – ensuring clean/dry bedding, clean litter boxes at all times. Ensuring all patients have water available unless specifically under order not to. Following prescribed diet orders, as well as recording amount offered, amount eaten, and adverse reactions
• Practicing critical thinking and independent thinking. Be aware of what tasks are most critical to be performed and doing those first (pain medication, insulin, temperature checks on a patient on heat, etc). Be aware of what types of care you usually give to patients and question if this is not being ordered (such as pain medicine in a fracture, anti-nausea medications in a vomiting patient). Notice and alert the doctor if there are other concerns regarding a patient (has not urinated since admission, no appetite, painful, straining to defecate, etc.)

Record Keeping

• Entry of the vital signs and medications given to each patient into the computer and writing them down onto each patients treatment sheet which holds all orders pertaining to that patient that is overseen by the doctor in charge of the case
• Making sure all charges are appropriately entered with specific amounts recorded
• Giving and Receiving Nursing Rounds on each patient in ICU plus other dog/cat wards in the hospital
• Ensuring that eliminations are recorded on the treatment sheet and electronic record. Ensuring the doctor is informed if there is an abnormality

Care of the ICU

• Cleaning of the ICU to meet infection control guidelines. Delegating cleaning tasks to assistants as necessary. This includes but is not limited to daily cleaning/disinfection of patient housing, surface cleaning/disinfection in ICU, mopping, sink cleaning/disinfection
• Aid in maintaining/properly using equipment within the hospital. Including but not limited to oxygen cage, anesthesia. machines, blood pressure/SP02 and resp. monitors, syringe/IV pumps
• Organizing the working area
• Ensuring needed items are in stock and delegating restocking to assistants as necessary

Procedural Support

• Aid in the intubation/sedation/anesthetizing of patients as needed
• Restraining patients for procedures/exams for doctors
• Performing CPR
• Answer phones if needed
• Actively participate in hospital’s day to day function by taking on additional responsibilities as needed
• Answer phones- they ring constantly; “Thank you for calling Central hospital for Veterinary Medicine, this is _______________ how may/can I help you?”

Work Environment:

• Clean and well organized ICU and treatment area
• Easily accessible medical equipment and supplies
• Noisy conditions can occur
• Protective equipment for nervous animals is easily accessible

Recovery- Secondary

General Description of Position:

• The recovery nurse is primarily responsible for the postoperative care of routine member doctor surgery and dental patients. They are also expected to assist with pre-operative workup prior to surgery. When these tasks are complete/not actively required, this nurse is expected to assist ER nurses as needed due to the proximity of the recovery area to the ER, as well as complete other necessary daily tasks to ensure the smooth daily flow of the hospital.

Essential Functions:

• Report to work
• Must be an experienced veterinary technician. CVT or other licensing is preferred but not required
• Good communication skills with coworkers and clients
• Able to draw blood, place IVC, and run bloodwork
• Knows how to take x-rays/proper positioning
• Able to sedate patients and monitor while under sedation
• Can lift and restrain up to 40lbs
• Can monitor anesthesia
• Knows basic math calculations for medications
• Can work efficiently and multitask

Member doctor surgeries/dentals

• Assisting in obtaining and performing pre-anesthetic blood work
  • Chemistry/CBC/Lytes/Snap Tests/Urinalysis and SediVue. Set up certain assays/tests/biopsy/Cultures/Cytology etc to be sent out to Idexx. Maintaining responsibility for in house tests and diluting appropriately when results are out of range
• Placing IV catheters and completing any pre-operative treatments
  • Following CHVM IV catheter placement and care protocol
  • Starting IV fluids, giving anti-emetics, assisting with pre-medication
• Assisting with induction of anesthesia if needed
• Recovering patients after procedure is complete
  • One on one with patient until extubated, and performing extubation
  • Taking/monitoring vital signs/blood pressures, etc. Recognizing when these vital signs are abnormal based on type of patient, age, and disease process, and reporting these to the doctor
Giving medications/IV fluids in all routes of administration- oral meds/injectable meds
• - subcutaneous/intramuscular/intravenous. Consulting protocol book or prescribing doctor for instruction of administration of unfamiliar drugs
• Ensuring all prescribed treatments are completed within the ordered time period.
• Placing e-collars that are to go home with the patient when appropriate (aka. right after surgery, upon wake up, before going home)
• Removing IV catheters
• Transferring overnight patients to ICU/cat ward/dog ward and rounding the ICU nurses following rounds protocol
  • Treatment sheets, regardless of pet location, are to be placed in ICU with the nurses (never in the cat or dog wards)
• Offering food and water as appropriate (ordered by doctor)

Record keeping

• Checking treatment sheets for orders, as well as if pets that are staying overnight have a sheet prepared for the next day with highlighted treatments (minimal attitude checks and BID vitals)
• Completing hourly notes for all member doctor cases
• Entry of the vital signs and medications given to each patient into the computer and writing them down onto each patients treatment sheet which holds all orders pertaining to that patient that is overseen by the doctor in charge of the case.
• Making sure all charges are appropriately entered with specific amounts recorded
• Ensuring that eliminations are recorded on the treatment sheet and electronic record. Ensuring the doctor is informed if there is an abnormality.

Other Patient Care

• Compassionately, calmly and gently approaching and handling patients. Practice Fear Free techniques whenever possible.
• Approaching and handling patients according to safety protocols and core values.
• Practicing basic animal husbandry – ensuring clean/dry bedding, clean litter boxes at all times. Ensuring all patients have water available unless specifically under order not to. Following prescribed diet orders, as well as recording amount offered, amount eaten, and adverse reactions.
• Practicing critical thinking and independent thinking. Be aware of what tasks are most critical to be performed and doing those first (pain medication, insulin, temperature checks on a patient on heat, etc). Be aware of what types of care you usually give to patients and question if this is not being ordered (such as pain medicine in a fracture, anti-nausea medications in a vomiting patient). Notice and alert the doctor if there are other concerns regarding a patient (has not urinated since admission, no appetite, painful, straining to defecate, etc).
• Checking patients prior to discharge
  • Removing any blood around patients’ mouth, incision, IV catheter leg, etc.
  • Brush out long fur that may have been wet down from dental work
  • Clean e-collars if dirty or soiled
  • Check hind end for urine/feces and clean if dirty

Other tasks/assisting ER

• Completing crash cart checklist if not done
• Cleaning of the workspace to meet infection control guidelines. Delegating cleaning tasks to assistants as necessary. This includes but is not limited to daily cleaning/disinfection of patient housing, surface cleaning/disinfection, mopping, sink cleaning/disinfection.
• Aid in maintaining/properly using equipment within the hospital. Including but not limited to oxygen cage, anesthesia machines, blood pressure/SP02 and resp. monitors, syringe/IV pumps.
  • Anesthesia stations
    • Disconnect oxygen, breathing hoses, bag (drape over machine so they are nearby each)
    • Clean up, put away extraneous things (ET tubes, eye lube, tape, laryngoscope…)
    • Wipe down anesthesia machine/vaporizer/flowmeter with disinfectant or alcohol wipes
    • Straighten up the items hanging from hooks
• Organizing the working area.
• Ensuring needed items are in stock and delegating restocking to assistants as necessary.
• Cleaning/disinfecting clipper blades
• Straightening out the laundry stacked over cages
• Being available to assist with ER patients if asked to do so
• Being familiar with CPR and able to assist when needed
• Answering phones if needed.
• Actively participate in hospital’s day to day function by taking on additional responsibilities as needed.
• Answer phones- they ring constantly; “Thank you for calling Central hospital for Veterinary Medicine, this is _______________ how may/can I help you?”

Work Environment:

• Clean and well organized ICU and treatment area
• Easily accessible medical equipment and supplies
• Noisy conditions can occur

Protective equipment for nervous animals is easily accessible