Critical Care Nursing
Have you ever thought about doing critical care nursing? Or wondered what it is actually like? There's definitely a big difference between the television drama version and the real life hospital version. On the television, the ICU is full of doctors constantly coding patients and then the patients thanking them as soon as their heartbeat comes back. Is this what the ICU is really like?
I do think that the real ICU nurse is different from what the general public often thinks it is. Some nights are busy and chaotic if you have an unstable patient, but many nights are simply full of tasks to be completed. A stable (but critical) patient requires a lot of attention! Even for these patients, you get to be a person of many talents.
Many of the patients are considered to be "total care" patients, meaning that we do everything for them! I remember one patient that came into the ICU in respiratory distress. Within two hours she had an endotracheal tube (to breath for her), urinary catheter (to drain her urine), a central line (to infuse multiple medications), an orogastric tube (to decompress her stomach), a rectal tube (to drain her stool), and an esophageal temperature probe (to monitor her core body temperature). Talk about total care!
Patients on ventilators are repositioned in bed every two hours, have their mouth cleaned every four hours, and are bathed by the nursing staff at least once per day. It is such a great service to be able to provide to these patients. They literally can do nothing on their own. You get to be their personal "beautician" in a way!
When it comes to end of life care, the patient's family is just as much a part of your care as your patient. This is often the worst experience of their lives. They will be losing their loved one. I was participating in a code just the other day and there was one nurse who (without saying a word) seemed to designate herself to emotionally supporting the family as the code progressed. As a nurse, you need to be a shoulder to cry on, someone to talk through things with, or even the person to give the family space to grieve.
The end of life talk is often started by a bedside nurse. Knowing how to bring up these topics and be sensitive to the family is of utmost importance in these situations. Families will ask many difficult questions and need someone to process the answers with. I have found that it is often in the quiet moments (not when the doctor is "having the talk") when family start asking the heart wrenching questions.
As a critical care nurse, you have definitely got to know your medications! There are certain drugs only to be administered in the ICU because of their potency. A couple of examples are vasopressors (continuous IV medications to help raise blood pressure) and IV insulin (used to lower blood sugar in extremely hyperglycemic patients). These are both medications which the bedside nurse titrates depending on vital signs, blood sugars, etc. If a patient has a low blood pressure, we turn up the vasopressors. If their blood sugar is dropping too quickly, maybe we decrease the dose of the IV insulin. This is one aspect of critical care that I love! I have parameters set in place for these medications and I get to titrate them accordingly. This also gives the bedside nurse a great deal of responsibility when caring for these patients! This is precisely why you usually have only two patients to care for.
All critical care nurses must be Advanced Cardiac Life Support (ACLS) certified. Codes are not an uncommon occurrence in the ICU; the one thing that is nice is that usually you see them coming. It's usually not like in the movies where suddenly someone flat lines and a whole flood of people are there doing little compressions until the patient wakes up and breathes out the words, "Thank you." Usually a patient has been struggling for a while, is already on multiple medications and the breathing machine for support, and then their illness simply becomes too much for their body to handle. As a critical care nurse, you get to participate in every part of the code: initiating the code, administering medications, performing CPR, recording events, and more. It's amazing to watch as a patient's heart rhythm changes from asystole, to ventricular tachycardia, to a normal sinus rhythm, all within three minutes! You've definitely got to be familiar with your cardiac rhythms to know what to do next.
One of my favorite parts about critical care is being able to explain to patients what on earth is going on with their bodies. Why do you have a low blood pressure when you have a widespread infection? Why is it time for a tracheostomy to be placed? Why can't I just drop your blood sugar from 800 to 120 in an hour? I feel like each shift I learn so much about how the body works and what the interventions we are performing are REALLY doing to the patient.
I always tell patients to write their questions down as they come up with them and then ask, ask, ask away! Understanding medicine for them may be like us trying to understand how a super computer works! I try to break down everything I'm doing into the simplest of terms so they can understand what I'm doing and why.
So What Nurse Would Want To Do That!?
Critical care is a an area that is constantly challenging you as a nurse. There is such a wide variety of responsibilities changing from patient to patient. From code browns to code blues, there is always some patient in need of a nurse to help them. It is not always the most glamorous job when dealing with an alcoholic going through withdrawals, but it is well worth it. It dawned on me one day that every patient that comes to the ICU would die without whatever intervention we were performing. Who doesn't want to be an instrumental part in saving someone's life?
Other relevant articles include: