The ICU Nurse

Quizzes and essays everyday. Skits, case studies and hospital crisis situations to study. Drug and their mechanisms of actions to memorize.

Nursing was no joke; in fact, at the time I could have sworn it was the hardest thing I had ever attempted.

But textbooks don’t bleed. Dummies aren't real. Flashcards aren't at the tips of my fingers anymore now. I’m a brand new nurse working in the intensive care unit.

I am attracted to critical care nursing because of the challenges and rewards of taking care of very sick patients in a fast paced environment. Here in the SICU my nursing skills are crucial to the patient's survival and my role continues to evolve.

It’s a circle. You work yourself from beyond the outside in, leaning on experienced preceptors and nurse managers. I received an overwhelming amount of support from the Specialty Nurse Trainees ahead of me and my preceptors, the nurses from the RNHeals Program, and mentor, the Regular Nurses, the experienced SICU RN. They often tell me that the first year in the ICU is just like school; after work you must go home and study everything that was new to you that day. I did what they told me. I gave more time in reading and reviewing my Medical-Surgical notes. Now that I am a bona fide nurse and practicing my skills to actual clients, more responsibility and care are rested onto my hands.

People ask me what is the biggest change in nursing over the years, and my answer is advancements in both technology and medications and also the patients themselves. Many of the patients I care for in the SICU would not be alive 10 or 20 years ago. New technology and medications are wonderful in that they give more patients a chance to survive and live longer but the problem is that when they come to me, patients are now more acutely ill than ever before. The bottom line is that patients now need more care and attention from the nurse. The assumption is that with the developments in technology and medications there is less need for the care by a nurse. But the opposite is true. The more need for the care by a nurse to the client. High-end Scans and State-of-the-Art Machines may worth millions but are useless in the absence of a skilled nurse. We nurses should be more keen and skilled now that we have these technologies.  There are things that advance machinery cannot do and provide. That is what we are here for.

Learning is a step by step process. In critical care nursing, first comes the responsibility of learning how to be safe; such as learning safety checks and what supplies and alarms need to be set up in the event of an emergency. Then come simple tasks, such as turning patients and monitoring their vital signs. More complex tasks; drawing frequent labs, understanding what lab values mean, and communicating with the health care team – soon follow.

The nurse is often the first health care provider to pick up on signs of poor organ function or poor body perfusion – I’ve learned how to voice these things to my team. One of the most intense experiences I experienced was coming back from a procedure.

My patient’s oxygen saturation monitor was quickly trending downward. By the time we reached the patient it was reading in the 70’s. I remember immediately activated the code and having the full support of my fellow nurses, charge nurse, clinical lead, respiratory therapists and physicians. I answered questions about what happened during the procedure and followed orders from physicians. Any order I did not fully understand was explained quickly to me in a thorough manner; the patient had a positive outcome due to successful communication and efficient teamwork.

Recognizing adverse events was sometimes the most difficult part for me. These assessment skills are second nature for an experienced nurse. I need them in the ICU where a patient's health status can suddenly change. I had to learn that while turning Patient A is an important and necessary task, a hypotensive Patient B carries more weight. But what if both patients are in same level of distress? I still have a lot of things to learn. I am a registered nurse but I still have a lot of things to learn. Things that are not written in books and that only experience can teach.

I love being a nurse and love using my experience and skills to care for patients and their significant others at perhaps the most challenging time of their lives. But the expectations of nurses have become unrealistic. I cannot be in two places at once — and as patient's medical needs become more intricate, I become anxious that I will not be there at a critical moment to access a patient in need.

The process of transitioning from classroom to real world can be summed up in one word: TIME.

For the past three months I have been part of some patient's recovery and last line of defense. And I wish to continue to be there until I can no longer provide safe care.

I found that Veteran’s Regional Hospital and Trauma Center (VRH & TC) offered me excellent resources, tools, experienced co-workers willing to help me learn, and nurse managers ready to go “the extra mile” to help see me get through this transition.

To everyone: thank you for the giving me the chance to hone my skills and to broaden my knowledge in the field of critical care nursing. I wish to learn more, so please, be kind enough and do have the indulgence of giving us more time and patience so as to know more of the secrets a competent critical care nurse has.