I recently had the opportunity to be a guest blogger for Stephen at Page the PA – he is a rock star on Instagram sharing his experiences as he goes through PA school. He is doing his ICU rotation soon, so I thought I would tell him a few secrets from this veteran ICU nurse! Please connect with him on IG @PagethePA and tell him I sent you!!
When most students, rotate through the ICU, they literally enter another world in health care. Whether they are new residents on service for the month, PA students, medical students or nursing students, the ICU experience is like no other rotation. Sure, you may have seen a few sick folks, but ICU patients take that to a whole new level. It’s a smorgasbord of problems – all in one human fighting to survive. It’s the land with more devices, tubes and drains than any human should have to endure. But, there is nothing like caring for a patient with multiple, often competing problems. The challenges are endless and the environment is often fast paced and demanding. But for a visiting student, it is certainly intimidating.
So, here’s a few tips from this 20-year ICU nurse that will hopefully make your experience a smooth one and ultimately make you want to come back for more!
Not your average nurse
No nurse is an average nurse or “just a nurse” – they are all rock stars in their own right. And just like any specialty area, the ICU nurse usually have a boat load of crazy knowledge! Most have gone through extensive training and orientation to be able to care for these complex patients. Their knowledge of disease processes is unbelievable, not to mention their command of titrating multiple drips and wrangling the myriad of machines that are connected to their patients. The expectation of knowledge is incredible. In fact, lives literally depend on their quick thinking and ability to instantly analyze data and respond quickly and appropriately. But, more importantly, the seasoned nurse have what no book can teach you – intuitive knowledge from experience. They have seen a few things and in turn could teach you a few things. Bottom line, become their friend and you will learn more than you could imagine. And if they are “suggesting” something for their patient – take note, it’s probably important.
With all this knowledge comes responsibilities. The ICU nurses have a very autonomous role. They have protocols they can function within and are able to respond to their patients’ needs long before they have even contacted any providers. Don’t be surprised that a patient’s status changes and problems are already being managed even before you are notified – that’s what they are expected to do and they thrive in this autonomous position. So, if you REALLY want to know what is going on with your patient, the first stop should be to chat with the nurse. And if they are calling you for something, take it seriously, they probably have exhausted all they have in the arsenal and need more support.
The average day of an ICU nurse is usually a busy day. Even the stable patients have multiple care needs that need to be attended to. So, although you may be there to see the patient now, know that the nurse has care that needs to be done, often in a timely manner. Their day is consumed with a never ending list of tasks – frequent assessments, monitoring vital signs, responding to changes, giving medications, treatments, nutrition needs, basic care, coordinating with other members of the team – all while still trying to document all the care provided. So, respect that they have a job to do also and it can’t always just stop because you are there to see the patient.
Fierce Patient Advocates
Nurses are usually loyal to one person – the patient. They take their advocacy role seriously and the ICU nurse is no exception. They are accustomed to caring for vulnerable patients and families and often become very close as they assist them through this difficult time. As consultants come and go, it is the nurse who is at the bedside 24 hours a day. The ICU nurse is who the patient and family turn to for support, comfort and questions. They trust us and know we will advocate for them. So, if an ICU nurse is calling you to talk to the family, they likely already have, but feel the family needs more questions answered. Remember, in the ICU, family care is just as important as the fancy medical care we provide.
Calm Under Pressure
After seeing a few floor codes, what usually catches many ICU visitors off guard is the controlled environment during a crisis or code. The ICU staff are trained to respond to emergencies and often have seen it coming, so it’s no surprise. Most seasoned nurses have been through many code situations and often are the first responders to those wacky floor codes. So, put away your ACLS handbook – nothing makes us more nervous – and sit back and watch the symphony of organized chaos – don’t worry, we’ll tell you what to do.
So, imagine if your daily routine consisted of facing death daily. Watching those who shouldn’t have died pass away, while other linger for unknown reasons only to suffer in their final moments. The ICU is where reality and ethics collide – where death is a friend and a foe, but always around reminding us of our mortality. Even in the best deaths, it still takes a toll on your soul over time. And before the empty bed can get cold, another patient is ready to take up the fight. The pendulum swings again. It’s not healthy coping to not be able to process the loss of a human, but it is the business of health care – someone sick needs care. So, the staff may seem a bit cold and calloused, and often with a strange sense of morbid humor – but this is how some cope – right or wrong – it is what gets them through the day. Just roll with it and don’t judge.
Well, I hope you have a little insight into the inner world of the ICU nurse – we are a tough, strange super Type A group – but we love what we do and our patients certainly benefit from level of dedication!