What kind of a person works Acute Care?

CrufflerJJ, BSN, RN, EMT-P · Nov 5, 2009

Does one need to be particularly hard core for this? I'm new to nursing, applying to BS/MS program; and am choosing Acute Care as my speciality because gerontological isn't available (I hope to be able to switch to that later on -- but that's another question for another post that I've already put up).
Any words of advice would be so much appreciate.
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Depends on what you mean by "hard core."

The word that best describes a lot of nurses in my unit is ANAL (and that's a good thing). They don't assume things - they check, recheck, and verify stuff for themselves. Acute care in my ICU is high stress, alternated with periods of less stress. Very ill patients...very fragile...looking good one minute, crashing the next. A very high level of attention to detail would serve you well in an acute care setting.

clearly · Nov 5, 2009

Thanks so much for the reply. ANAL is great. I can do that; & I prefer to be like that.

How emotionally involving is it, though? Also, how much responsibility is in the care of the nurse? For instance, do you have an example of a major procedure that a nurse might have to perform?

I am concerned about whether I can handle seeing the pain. I know that going into nursing requires me to become a stronger person but I am just trying to gauge what lies ahead for me in Acute Care which is supposed to be reasonably different from another speciality. (I'm not weak hearted but I tend to over-empathize and this has been my college professors concern when I indicated I wanted to go into nursing -- but I am sure I can learn to manage that and maintain a professional emotional stance.)

CrufflerJJ, BSN, RN, EMT-P · Nov 17, 2009

Thanks so much for the reply. ANAL is great. I can do that; & I prefer to be like that.
How emotionally involving is it, though? Also, how much responsibility is in the care of the nurse? For instance, do you have an example of a major procedure that a nurse might have to perform?
I am concerned about whether I can handle seeing the pain. I know that going into nursing requires me to become a stronger person but I am just trying to gauge what lies ahead for me in Acute Care which is supposed to be reasonably different from another speciality. (I'm not weak hearted but I tend to over-empathize and this has been my college professors concern when I indicated I wanted to go into nursing -- but I am sure I can learn to manage that and maintain a professional emotional stance.)

It can be VERY emotionally involving. You're dealing with very sick patients, and some of them are going to die no matter what. All you can do is to give the best care possible, and advocate for your patients so they get the best care possible. There are times when you need to have discussions with the family and let them know that their loved one is not doing well, and the only thing keeping their body alive are the eight IV drips, the ventilator, and the continuous dialysis machine purifying their blood. You'll have to answer tough questions with sensitivity & honesty.

In acute care, the responsibility doesn't so much take the form of a procedure you'd need to perform. You're not going to be cracking their chest or placing a chest tube. The responsibility is that you must remain constantly AWARE of your patients, know how their labs have been trending, watching their sats/blood gases, staying on top of managing their other symptoms (pain/nausea/...). Your awareness has to be good even when you have a "stable" patient, since it doesn't take much time to flip from "stable" to "crashing." It could be a subtle change on oxygen sat or ventilator pressures that would require you to act (double-check things, try to figure out what might be going on, then call the doc). It could be noticing that your patient's electrolytes or CBC is screwed. It could be a change in patient behavior, even though all the monitors & other "infernal machines" attached to the pt say that everything is peachy keen fine (when it's not).

Sometimes, it's painful to watch a patient die. If you have someone admitted to your unit in obvious distress, and the patient's family is debating among themselves about whether they want us to "do everything possible" vs "comfort care only", the patient can suffer in the meantime. It can be painful to watch the family suffer as their loved one dies.

Despite the emotional risks, acute care is an amazing environment - very challenging, with tremendous opportunities to learn and care for your patients and for their family members.

MauraRN · Nov 17, 2009

You quickly develop a "gut feeling" thing when dealing with patients. Sometimes I can tell just by looking at them that even tho assessing the ABCD's (airway, breathing, circulation, disability (neuro) are within their baseline, if your gut is telling you something, investigate further. Trust your intuition if you get that gut feeling and you will likely find something that fell thru the cracks, or some adverse event that is brewing in the patient. Develop your assessment skills so that you have the confidence to trust your intuition. Can't say how you will react to pt pain, death, families, etc. If it is not for you, consider the "happier" practices,i.e., L&D, well baby clinic, school nursing. Good luck!

MauraRN

clearly · Nov 18, 2009

Thank you both so much for your elaborate descriptions. This was greatly helpful; it was exactly what I was looking for insight on! Totally on-point and really well-explained. Thank you bigtime :)

shoegalRN, RN · Nov 19, 2009

I am a new grad in the ICU and I will tell you, yes, I am ANAL about little details. I pay close attention to all the details if I can help it.

I am still working on getting the flow of the ICU down, as well as all the tasks, and I am also trying to develop my nursing judgement as well. If there is a spike in labs (2 points one way or the other) then I'm looking at labs from two days before. If this is not the trend, I'm calling the doctor to see what can be done.

I pay close attention to the monitor and IV pumps going off. If a pt is on a pressor, if I hear that IV pump go off, I'm running to the room to make sure there is enough volume left in the bag, if so, I'll adjust the volume on the pump and run and get another bag and leave it at the bedside, so when that volume does start getting low, I can change the bag without having my pt crash on me.

I pay close attention to the monitors and how they alarm. If my pt has a run a of V-tach, I'm running to the room to check on them. Same with O2 sats dropping.

If my pt has urine output of less than 30 ml in 2 hours, I'm calling the doctor to see if we can give a bolus of NS, or give some Lasix, if pt has some edema going on. However, if the pt has a history of renal failure, this may be the norm, but still, I'll call the doctor and let them know.

I'm still learning and got a lot more to learn, but I can tell you that working in the ICU, you have to pay close attention to little details that can possibly save someone's life.

elkpark · Nov 19, 2009

Does one need to be particularly hard core for this? I'm new to nursing, applying to BS/MS program; and am choosing Acute Care as my speciality because gerontological isn't available (I hope to be able to switch to that later on -- but that's another question for another post that I've already put up).
Any words of advice would be so much appreciate. --

You mention applying to a BS/MS program -- are you asking about being a general acute care RN, or an acute care NP?? These are two entirely different worlds.

clearly · Nov 19, 2009

Great question! I'm applying to be an Acute Care Nurse Practitioner. Please describe how the two are completely different worlds??

elkpark · Nov 19, 2009

Great question! I'm applying to be an Acute Care Nurse Practitioner. Please describe how the two are completely different worlds??

The nurse practitioner role is entirely different from the staff nurse role. As an NP, you are taking direct responsibility for the diagnosis, treatment, and outcomes of a group of clients. It is much more similar to being a physician than it is to being a staff nurse. If you're asking this question, I have to wonder how much you've researched this before making the decision to apply to a direct-entry NP program?

clearly · Nov 19, 2009

I knew the difference; was just waiting to hear the particular details of different challenges associated with NP experiences from you. I'm taking it all in (hearing about RN experience as well as NP experience) because I still have the B.S part to go through..so I appreciate hearing how it all works, you know?

Trauma Columnist · Nov 19, 2009

So...in this direct entry program, you obtain a BSN, work as an RN for some amt of time then go for the ACNP?

Just asking because usually ACNPs are very experienced ICU or other acute care nurses.

I don't mean to rain on your parade, but have these grads found jobs easily? In my neck of the woods (and I do mean woods), the NPs and other APNs that are being hired, have years of RN experience. Whats the track record of the school.

If you like, I will move this thread to the NP forum where you might find more answers from people taking this route.

Good luck.