Critical care nursing

LesJenRN · Mar 24, 2004

I knew I wanted to work in critical care after I had my first clinical there....What appeals to me is that you work very closely with 1 or 2 patients at a time. You really get to delve into the pathophysiology of what is going on, you have time to assess everything and because of that are able to be on top of things....We have more autonomy and closer collaboration with the docs and other healthcare providers. I enjoy gettting to know the families of these patients.

Ask any ICU nurse....when we are floated out to a med/surg or tele floor...it can be miserable. WIth so many patients to care for in a shift there isnt the time to do full assessments, check on labs, xray, etc etc because you run run run on the floor. I have been floated and scramble to do an adequate job. Might find a patient in distress because you havent been in the room for the past hour...drives me nuts!!!! I have so much respect for those nurses that can do it!

Elenaster · Mar 24, 2004

I completely agree with LesJen's sentiments and would like to add that critical care nursing gives me the opportunity to utilize my critical thinking skills very frequently and in an in-depth manner. For instance, you may start to pick up on subtle changes in a previously stable patient that is going septic. Or you may have a patient whose blood pressure is suddenly sky-high, only to discover that his art line transducer in on the floor (this will give outrageously false readings). All-in-all, you have to be able to think quickly on your feet and be able to multi-task very well. I also think it helps tremendously to have an excellent pathophysiology base and a desire to be challenged in your work.

As far as our responsibilities, the most important thing IMO is "get to know" your patients very well during your shift. By this I mean thoroughly assessing them at the beginning of your shift, reading their past medical history, trends in their status since admission, and continuing to reassess them throughout your shift. I always try to figure out why the patient needs critical care, because often times it can be a bit of a mystery.

Sure we have to do a good deal of techinical stuff, like how to troubleshoot Swan-Ganz catheters and level ventriculostomies, but the key to being a good ICU nurse is being connected to and intuitive about your patients.

Dinith88 · Mar 24, 2004

Good posts! If i were to add anything it would be that critical care nurses have the most 'autonomy' when dealing with critical patients. By this, i mean in a crisis they're expected (and required!) to make many calls on their own. Most ICU's have standing orders that allow ICU nurses to order labs, X-rays, etc. if they feel the situation warrants. Of course the MD's are notified and guide the case, but unfortunately the vast majority of ICU's dont keep Doc's in the unit (bigger teaching hospitals are full of gun-slinging residents and such so they're a bit of a different story). If a patient goes bad, it's all you baby! (until you can get someone on the horn...in the meantime you had better know your stuff..or have a good crew with you). Of course, most other units dont have doc's on the unit 24/7..the difference is that when a patient starts to crash they're whisked away to the ICU as soon as possible. (followed quickly by a sigh of releif from the transferreing nurse)

A thing to keep in mind is that in the ICU, the buck stops there. Whether the patient comes from ER, another unit, elective surgery..whatever. They either get better...or they die.

CCU NRS · Mar 24, 2004

Yeah the previous posters have all made great points. I posted this on a thread about ceritifications these are the ones the strongly recommend in my facility.

IN my facility we are expected to get ACLS, take code blue class and then go on three codes and become a code blue nurse (we are in CCU but respnd and run codes anywhere in the facility when ccode called so there is someone on Codes every shift), go to a IABP class (intraaortic balloon pump)orient to a balloon pump with a cert nurse for 4 hrs then be IABP cert., then we are to take a CVVHD class and then orient 4/hrs and then be CVVHD cert, then we are to take a Heart recovery class and recovery three open heart CABG or Valve replacement with a cert nurse and then be Heart Recovery cert. then orient to charge for three shifts then be cert.

all of the reasons listed above by the first 3 are about the same reasons I would give. They all said it very well

zambezi, BSN, RN · Mar 25, 2004

I work in a CCU. I started there as a new grad. I went into the field because I enjoy the pace and the complexity of the patients. I admit--I also like the adrenaline rush (but only if it's not my patient causing the rush... :)

The other posters had good reponses about responsibilities, here is what I feel a critical care nurse does...

Critical thinking is a big one.We look at the entire picture and how everything relates to plan for the best outcome for the patient. We look and intrepret labs and determine whether the dr needs to be called for abnormal values and we take steps to correct the values (often through standing protocols). If a patients condition is deteiorating we look at the big picture to figure out what is going on and support the patient until problem can be solved. We can order ABGs, CXRs, Labs, etc to try and pinpoint problems based on what we see. Often there are standing orders that we have that can be used based on clinical intrepretation to guide our care (ie: to start vasoactive meds, for pain control, to give blood products, for codes, for extubation procedures, etc). We use technology to assist us in our care (vents, swans, icps, and many other things), We titirate medications that are very potent to manage clinical symptoms and "numbers" obtained from our technology. If the patient is actively trying to die, we take measures to save them the best that we can. On top of all that, we do basic care for the patient, keep them as comfortable as we can, take care of their emotional and spiritual needs and we support the family (which can be a big job in itself, LOL). We are the patient's advocate. We are the ones talking to the families to find out the needs of the patient (if the patient is unable to speak for themselves). We coordinate the patient/family wishes with the plan of care and to the doctor. Many ICUs do not have CNAs, so if your patient is vomiting or has frequent BMs, is impulsive etc, it us up to you to do the cleaning, turning, skin care, baths, feeding, safety issues, etc. It is a great job, both very technical and mechanical. I usually have time to sit and read through chart/history, etc. I have a close working realationship with the docs and a fair amount of autonomy.

I would suggest trying to get some clinical time while in school to see if it is an area for you, some people love it and some hate it. Good luck!

superaudree · Mar 25, 2004

Thank you very much for your replies. I can see how you are all passionate about working in critical care. But after reading your posts, I'm starting to wonder if it is for me. It seems like very stressful work and I think I'll be scared s*%#!!!

mattsmom81 · Mar 26, 2004

Critical care is not for everybody. After 5 yrs on medsurg/tele units, I knew I was ready for the detail oriented, more autonomous ICU setting. It has been my niche for over 15 yrs now. Many nurses I know do NOT like the stress of knowing 'the buck stops here' in their ICU...and that no matter what happens to that patient it is their responsibility. They do NOT like knowing they are held to higher standards by the doctors either. Others (like me) are not happy anywhere else.

Nursing is stressful wherever one works...its all about what floats your boat. Good luck!

superaudree · Mar 26, 2004

Are there any jobs in nursing that are NOT stressful, or not as stressful?

zambezi, BSN, RN · Mar 26, 2004

I think that stress is in the eye of the beholder...what is stressful for me may not be stressful for you or vice versa. That being said...I think that all areas of nursing are just a little stressful, after all, we are taking care of other people...when the things go bad, or if you are too busy to do the care that you want to do, the tendancy is to feel stressed. To me, working with 7-10 patients on the floor sounds stressful...I would rather have one really critical patient than 10 patients, but that is just me. Some people think it is stressful to have one "stable" patient in critical care. The great thing about nursing is that there are many areas that you can try to find what fits your temperament, ideals, skills, etc.

Some things to keep in mind as you are looking for a floor to work on:

Find a good support system within your coworkers, it is absolutely invaluable. Find a good orientation program that fits your needs, it is better that it is too long rather than too short. Have a mentor or buddy after you are off orientation. Try to find coworkers that you actually like...when I go to work, I feel like I am with my "other" family...it makes work more fun. Have fun at work...if you don't enjoy what you are doing you will burn out faster...become organized...organization means many things to different people, find what works for you and make a system, it will help you as you first start out (especially when things go bad). Realize that, occassionally, things do go bad...it's not about you...just do the best you can, ask for help, each time gets a little easier as you learn what to do. Remember that even if you hate your first job or feel incompetent, it does not mean that you picked the wrong field, mabye you are just having a bad day, that unit may not be the right fit...that's okay, there are other opportunities out there. Most of all, just do the best you can, that is all anyone can offer. Not all of your patients will like you- in fact, you won't like all of your patients (or their families, or the docs, or even your coworkers...you get the picture). Have confidence in who you are and what you know, every day is a learning experience. I wish you luck in finding a job that makes you happy.

shoelace · Mar 27, 2004

I started out as a new grad on med-surg, working nights.

The morning I put in my transfer to ICU came after a night where

I had 3 admissions, making 10 patients. It was the night from hell; very sick patients.

I did med-surg for 6 months and have done ICU for the last 6 years. I have never looked back.

bousheboo · Mar 27, 2004

undefinedundefined

Hi I am a older mom returning to school to become a nurse, I live in Sacramento ca and the community colleges are pretty cheap but you have to get into the lotto system to get into the nursing program. You may not get in, I am concerneda about the long wait of four and not being able to work while in school( I have three kids very young) CA is very expensive but I am told you make the most here and the ca degree is really respected is this true, because I hear that FLorida and many southern states are very affordable and just as good salary wise for nurses??