flo136

I have friends that hurt their back and were tired of the hard physical labour of adult ICU, and they went in neonatal ICU or paediatric ICU. Also a step 'back' in intensity is Recovery (post anaesthetic), or Anaesthetics instead. Everyone I know who made those transitions, looked heaps healthier and happier afterwards!!

I started in ICU, did the specialist ICU course after 6 months and 1 year's worth of consolidation afterwards. Crazy times! But after about 8-9 month mark, after getting the course under my belt, it clicked. I got sick patients and I could take care of them well. It fell into place, the anatomy and physiology of it, what to do, who to turn to for help. It just get better and I felt so much more confident. It wasn't, and still isn't, perfect 30 years later but that's okay. My mentor said after the specialist nurse course everyone is really good and knowledge is fresh; they are great to be around and work with. And I think give a job 6 months at least to find your feet. But I love ICU and I'm so glad I stuck it out. Covid-19 is super tough, so its hard to make a career judgement call now. You're a big help in a very tough time, so try to stay.

I did something similar years ago learning CRRT but forgot to document the fluid off amounts. I felt like rubbish because they thought I was a 'good' ICU nurse. However, the nurse in charge told me the problem, the solution; they fixed it up on the chart and said don't do it again. And they're right. As mistakes go, its not that bad and they've probably forgotten the event so you should too. Its really not that bad- there are far worse that goes on in ICU.

Certainly there are patients and families that can be 'challenging' with their requests but ICU is still an amazing speciality to work in. Every shift can be so different and exciting professionally. For those sorts of patients and families we have some plans: short shift allocation (no 12 hour shifts), a lot of getting colleagues to 'pop in' for requests instead of us, going for longer walks out to the sluice! Some times just helping in another bed space for a time can relieve the frustration. You're not alone! ICU has a turnover that means those situations don't last.

We've all had shifts like that. I find as much as I dread returning to work, it really helps to find out what happened to the patient. And talk to a trusted friendly colleague, someone whose opinion and work you admire for a different perspective. I like to go out in my local area and see healthy people out and about. As a change from all the distress and drama at work. Be out in the 'real' world. Do reach out to some support service if you can't shake this off. Reflection on critical events also counts for annual professional nurse registration (in UK and Australia) so writing a statement of the events and what you have learnt afterwards count too.

What happened?

I wish I had learnt more about managing agitated and confused patients. I always felt so useless managing them, so ineffective. Making time to sit down and talk with a patient and their family. I still really enjoy that after nearly 30 years doing nursing. But work is usually so busy, so many tasks and demands. That basic element of nursing is not really filtering down to our younger staff.

I'll be honest- the doctors on night duty lack much experience, let alone the guts to make big decisions. We often feel like we are just babysitting the patients until someone in charge with a clue can come in and actually make a definite plan. Its frustrating but it never gets better.

I love it when the visitors sit by the bedside for hours glued to their mobile phone. Or watch the whole unit work, not interested in their loved one in bed. Visitors- they drive you nuts! I've got my hands full enough already thanks.

I don't regret it. There is so much variety, every day is different, and what we do is so important. But I am finding it harder, 20 years down the track. I love doing critical care but I find today's nursing not particularly patient-orientated. Some of the younger nurses are not even very kind. They like the 'kudos' of crit care nursing. But I think I'll stay in this career for another 20 years. My whole family has done various types of nursing for over 50 years, and that is something important to all of us: to 'keep going'. Maybe you are just burnt-out?

I worked in an Australian city public ICU that had a burns speciality for 3 years. A few random thoughts that entered my head when I read your note: The rooms are really hot, which is hard to work in when you are in scrubs/gowns. The smell is awful- they always get infections. The dressings take hours (sometimes 4 hours). The skin is slimy and some staff assisting have fainted. There are usually some psych issues that surface when they get better. Either spacing out on all the ketamine they need for dressings; or trauma and stress from the incident. It's a tough area, but it looks good on your CV; and you hear and see some amazing things! Good luck.

I agree with all the comments of life-threatening situations: fast-paced, exciting, etc. But also I like the nurse:patient ratio and also the support available when things go wrong. I have equipment, manpower and expertise available instantly. It is scary initially, but it's a great place to learn about nearly every acute aspect of most specialities.

Give it a good six months. I felt like I made so many errors when I started. The patient deteriorated, and it was all my fault? Of course not, but I could not see why. I was so tired and stressed, the whole anatomy and physiology of intensive care was beyond me. But after a while it did make sense. It did 'click' and I got good feedback from my mentor. It did get better. But the first few months were really tough, and I didn't think I was any good at all. 12 years later, still in ICU, clinical nurse specialist. Some days it is crap, other days I love it. :)

I agree with the other posts about experience guiding inotrope titration. But also, with disease processes such as sepsis,or multi-organ failure, you will get a feel for how far to go up or down. For example, in sepsis, levo really can be moved up hard to get an effect.

Help each other out, without asking. Little things like turning pts, suction- all the two-hourly things we do. It's just done in time for breaks. And done well. Using each other rather than the access/in charge people. Takes the pressure off everyone.

I'd say also 'aorta'.

I'd say 3-5 years. I start to get really low about hospital politics and procedures after 6 months (the 'they-do-it-better-elsewhere' thing); but by 5 years I am really taking a sick day every month for my own mental health! I do love the job though. Can't imagine anything else would be as exciting, and at nearly 40 years old- don't want to try either!

I guess it depends if you believe in God! I agree we do prolong things now in ICU. And I do feel sad for those patients when you, and they, know the inevitable is coming. The hopelessness of it. But I am relieved when they do die, because ICU is a miserable place sometimes. Y'know- I often think 4 hours a day in a shop would be just great. Not thinking, or knowing, about ICU. But if you look at the stats for discharge out of ICU, and mortality, it's pretty optimistic.

We use Swans here all the time in Adelaide, Australia. The docs use them mainly for number-crunching. Seeing the trend in the numbers: SVRI not so much. More CI/CO. I don't think they are good. I have worked in the UK and larger Aussie cities that have managed on other clinical signs such as urine output and CVP for management. A lot of our Swans don't wedge. They let junior nurses use them which I find scary. I find PICCO is not considered an alternative either. It's all numbers here, but looking at the patient is better!

Here in my Australian public hospital, we do 4 CABG per day, 5 days a week. They do well. Some bleed and go back to theatre, but after that they're OK. Some come back on aortic balloon pumps, but after a few days they are off them. There are a lot of things they can do for cardiac patients if they run into trouble. In intensive care, we deeply sedate them for a few days, support all major organs and then move forward after that. The worst ones are the patients that are sick before theatre. Then you are fighting a compromised patient before the really big stressor of surgery. CABG are a hospital's "bread-and-butter". We do a lot of them everyday, and they all go well. They really do! Be brave for your mum.

I end up retching with them! Thank goodness I work in ICU where they are all intubated-yay!

I think you did the right thing. It was a peri-arrest situation so your priorities are Airway, Breathing, Circulation. ABC...not TPN. That can wait.

Because I make a difference in someone's life, and it is a big difference. You can be there at the last breath, or when everything is being done to save a life such as cracking open a chest. It is an amzing area to work in.I have done it for 15 years, and whilst there are stress and burnout issue, I still love it.

In Australia, dialysis aptients are 1:1. We use citrate rarely. We use the suction tubing hooked up to the effluent bags and drain them into a outlet in the wall, and reuse them too. 3 litre exchanges. 5 litre bags. We use Edwards Aquarius machines. As does most hospitals here. They certainly won out over Prisma.

I still would have held the meds. Does the Dr want the patient to go into arrest by the morning? If your colleagues agree, and we are educated people, then I don't get the big deal. Re:badness: we use Nipride every day here for our CABG's. Crazy. I hate it. And they stick it through syringe drivers, which is great when changing the syringe over. Huge BP swings.