Nursing Update

Hi there! Oh my word I can’t believe it’s been so long since I’ve written anything. A little over a year now! I never did get around to writing a post about a typical shift in the cardiac stepdown unit. Obviously this blog is no longer a big priority since I started it to record my journey through school and well, I’ve been graduated for a little over 3 years now.

3 years.

Wow. I can’t believe I’ve been finished with nursing school and have had a degree for 3 years already! And as of about a week ago, I’ve been a registered nurse for 3 years!

I appreciate all the comments in my absence and I’m so glad that this blog is still helping nursing students.

A word of encouragement: being a new nurse is tough and scary. Being responsible for lives and handling medicines that could potentially cause disability or death is not something to be taken lightly. But the experience and knowledge that is gained as time goes on at the bedside makes the job feel easier and the anxiety lessens and going to work suddenly becomes a privilege and no longer feels like a heart attack waiting to happen.

I transitioned into a medical/surgical ICU almost a year ago, and I finally feel like I’m HOME in the world of bedside nursing. I absolutely love being an ICU nurse. I feel like I’ve found my passion and this is where I belong and where I make a difference. I feel like my nursing world has a purpose. Friends, if you don’t feel like this in your unit, it may be time to shake things up.

My ICU handles many different surgical and medical conditions. Some of the more frequently seen medical conditions are sepsis, pneumonia causing respiratory failure, strokes, DKA, acute kidney injury/acute renal failure, post cardiopulmonary arrest, afib/aflutter, and hypertensive crisis/emergency, among others. And some of the surgeries we get are craniotomies, exploratory laparotomies due to bowel perforations, and laminectomies. We don’t see as many surgical patients as medical patients for sure, but I’m ok with that because I prefer the medical patients. We have the ability to care for patients on rotoprone beds for ARDS, CRRT (continuous renal replacement therapy – a slower, continuous form of dialysis), patients who have had ventriculostomies done and have EVDs (external ventricular drain) to decrease intracranial pressure, and hypothermia for post cardiopulmonary arrest patients who are eligible. And of course we have the usual hemodynamic monitoring through CVP lines and arterial lines.

It’s a busy ICU and our acuity stays pretty high. For example, about a month ago, we only had one patient out of the whole ICU that wasn’t on a ventilator (and our census was full, with PACU and ED holding patients for us!).

I’ve been able to take care of almost every type of patient with the exception of a hypothermia patient (we don’t get them TOO often) and a CRRT patient. I’ve taken the CRRT class and technically can have a patient on CRRT, however it’s just never worked out that I’ve been working when we’ve had a CRRT patient or they’ve been too unstable for me to take as my first CRRT patient. Hypothermia, CRRT, and organ donation patients are always 1:1 patients in my ICU which is nice because they’re usually very busy assignments.

I’m pretty sure I’ve learned more in just a little under a year in the ICU than I did in the two years I worked on the cardiac stepdown unit! Although I have to admit that I’m so thankful I didn’t start out as a new nurse in the ICU. Obviously it works out well for many new nurses but I think that it would have been detrimental for me. Not only are you learning how to take care of patients as a new nurse, you are also learning how to chart and learning how to navigate hospital life and hospital culture. I’m grateful that I had those two years prior to the ICU to get my basic nursing skills and assessments down, because when I moved into the ICU I hit the ground running and it has been a fast pace ever since! Also on the plus side, I really learned a lot about cardiac nursing and management of cardiac patients which I really appreciate because the ICU I’m in doesn’t really handle many cardiac patients (our hospital has a CVICU where the majority of the cardiac patients go).

There are some big differences between the cardiac stepdown unit and the ICU. In the stepdown unit I was responsible for 4-5 patients per shift. We didn’t usually have more than 2 patients at a time who were on a cardiac drip such as amiodarone or cardizem; in fact it was more common that my patients were saline locked other than scheduled IV antibiotics or maybe had continuous normal saline running. We rarely had patients with NG tubes or other invasive equipment. Most of our patients could get out of bed independently or with assistance. They were monitored remotely with telemetry. Our patient care technicians got all of the blood sugars, did baths, emptied foleys and urinals and toilet hats, recorded vital signs every 4 hours (unless a patient was on a cardiac drip), and helped feed and otherwise assist patients when the nurses weren’t available. Because the nurses had so many patients, we were responsible for medication, assessments, educating the patient when possible, and charting.

In the ICU we have 1-2 patients (sometimes 3 if we’re really short) per shift. Our patients are usually critically ill and on several drips to manage/treat their condition; in fact it’s rare if the patient is only on maintenance fluids or saline locked. They can have central lines, PICC lines, NG/OG or PEG tubes, foleys, rectal tubes, EVDs, chest tubes, wound vacs, etc. Every patient is monitored from the room with vital signs being taken every 15min-1hr; those vital signs then populate into the chart automatically (other than temperature, unless the patient has a temperature probe in their esophagus, rectum, or bladder). The nurse is responsible for total patient care, including baths, turns, feeding (when they’re alert enough to have a diet – which is rare), etc. We have patient care techs in the ICU and they’re available to help, but many of them also act as unit secretaries, stock the unit, transfer patients, etc. They are also responsible for blood sugars (unless the patient is a DKA patient, in which case the nurse usually does the blood sugars or the nurse and patient care tech alternate every hour). Nurses are completely responsible for the intake/output record per patient and so therefore must empty foleys/drains and record the intake from food trays. Patients don’t get out of bed often in the ICU (unfortunately) and when they do it’s usually with PT. Nurses are responsible for drawing blood for labs/blood cultures and taking the patients to MRI/CT.

There are other differences but this explains the biggest differences between the two units for me. And of course, in the ICU, the patients are sicker and so I do maintain MUCH more contact with physicians and family members. My assessments are much more thorough and I have to recognize subtle assessment changes quickly because most of my patients aren’t alert or able to communicate well with me. And in the ICU we rely on teamwork way more than I ever had to in my previous unit.

I can’t promise any posts any time soon but I will try to update a little more regularly. My upcoming plans in my nursing career this year are to study for, take, and pass the CCRN certification. I also want to take a preceptor class at my hospital and begin precepting new nurses and new employees. And I’m beginning to seriously think about beginning DNP school; the program I’m really interested in only takes applications every December though so I’ve got some time before I have to make a decision about that.

If y’all have any questions or would like me to write a blog post about something in particular, please let me know!