I’m an ICU nurse, AMA

[Pinkplasticbathcup]

I guess there may have been a few of these a couple of years ago, but in case anyone’s got any more questions

@Pinkplasticbathcup

What level of autonomy and responsibility does a band 5 ITU nurse have that a band 5 ED or surgical ward nurse doesn't?

@Obeythedancecommander I'm sorry about your dad.

Yes, definitely moving someone can cause them to deteriorate very swiftly when they are on the edge of life. There can be fluid shifts in the chest or abdomen, (parts of lung that were working can fill with fluid or fluids in the stomach can move squashing the bottom of the lungs) or their heart simply can’t cope with working that little bit harder to keep them stable as they are turned.

The nurses would have been very sad it happened like that. We always have to think hard about whether to move someone in that situation as it’s very common for them to deteriorate afterwards. But equally we want to keep them decent and clean and dignified (I know you didn’t say you were upset he was moved but just for anyone else reading).

Once again sorry for your loss.

Thankyou ❤️

@BankOfDave yes both of those are true, and the diary practice is a direct attempt to reduce the PTSD that many of our patients experience.

Are you in favour of assisted suicide? I am.

@HelloNeighbour2021 I’m so sorry to hear about your dad.

In all honesty I can’t comment too specifically as I wasn’t there - did anyone mention that he had a brain injury due to lack of oxygen during the arrest?

With regards to the cooling, current resuscitation guidelines state that that patients should be kept at a normal temperature for a minimum of 72 hours. As long as your dad didn’t have a high temperature I think it was reasonable to take the cooling off, with a view to putting it back on if he became febrile (high temp).

Have you contacted the ICU to see if they have a follow up clinic? Somebody may be able to go through the notes and debrief you a bit. Or there is a link up thread to ICU steps who may be able to help you.

There are barely any covid patients that I know of in ICU’s these days. Lots of flu though. Unfortunately I work now in a very specialist centre where we haven’t had any covid for months, so I don’t know the treatments or outcomes, sorry.

If we have a patient with known severe mental health problems (unstable schizophrenia, psychosis etc) we’d get one of you guys as they were coming out of sedation or sometimes long term depending on the severity of their mental illness. Lifesavers cos we wouldn’t have a clue what to do!!

@Fordian depends on the day!

Nah it’s all good - it’s got to be done.
Just don’t ring up to ask me have I tried to get an aspirate when I’ve booked a CXR for NG confirmation 🤯😡🤣

Hi, and congratulations on almost finishing your course!

I would say be prepared to have to do a lot of reading in your spare time at first. There will be an awful lot of physiology and pathophysiology you’ll need to learn relatively quickly.

When I first qualified (which was a long time ago now) I found the responsibility, and the legal element to that responsibility, quite overwhelming. If you do feel that then speak to your mentor or find out if there is psychological support you can access.

And finally I’ll leave you with the advice an old timer gave me when I was an exhausted and overwhelmed new grad - as long as they’re clean, dry and alive when you hand over, anything else can be dealt with. Remember that.

Good luck and welcome! Xx

Yeah it was a bit of a knee jerk reaction. And yes of course the answers were accurate and I’m sure they are a great doctor and seem very respectful of the nurses they work with so I wish I hadn’t said it really.

I do have fabulous working relationships with all the doctors I work with and we don’t perpetuate stereotypes in my unit!

I’m so sorry for your loss. I can’t imagine how horrendous that must have been.

I would say definitely send a card. Even if she doesn’t remember you it will give her a lift to think you still think of her after several years and that she did such a good job in such awful circumstances for your family.

I would be very touched to receive such a card even several years later xx

@Sophoclesthefox I’m so sorry your loved one is a patient at the moment. I hope they are stable or improving even a tiny bit.

Its difficult for me to advise you what I would do in your situation because my level of understanding of what would be going on is so different to yours, I would be asking for huge amounts of very complex medical info and I don’t think that’s appropriate to advise you to do.

I think you should be asking for (and concentrating on) whether your loved one is getting better when the big picture is taken into account. Families can often get very hung up on specifics ie. has the level of oxygen on the ventilator changed by even a tiny amount or has his blood pressure/heart rate changed by a tiny amount. The situation is often so dynamic with very sick people that minute by minute changes are almost irrelevant. Also asking how many and which organs are affected by their illness. Try not to get too hung up on the monitor - that’s what the nurses are for and they will respond appropriately.

With regards to doing your best for them - just you being there to support them is so important. Bring in photos, things they like, play music. Their own toiletries. When/if they wake Bring in something like a scarf with their partners or child’s or their own perfume. You are the person there who will treat them as a person, not a patient. With the best will in the world the clinicians can be so focused on the numbers they do sometimes forget there’s a human in there. Bring it to the forefront for them.

And finally you must rest too. I always advise my families to go and sit in the garden (we have a little one at the hospital) and take 10 deep slow breaths. Try to eat and more importantly to drink. I know sleeping might be hard but just lying down and resting is beneficial. Take time away as it might be a very long hard road and you need to be able to stay the length of it. Best of luck xx

I’m sorry you had to visit us, but glad you had a good experience!

I’ve not done much paeds @wideawakemummy but certainly it’s normal for adults sleeping patterns to go haywire. He’s probably still feeling poorly and scared and confused by it all. Keep loving on him and holding him (take turns with anyone who can give you a break!) and hopefully he’ll settle down.

That must have been so so scary. Sending hugs xx

@Botw1 I’m sorry if I’ve offended you.

I suppose when I talk about autonomy and responsibility I’m taking about all the independent changes that are made to a patients treatments after assessment.
For example, a band 5 (post course) would change ventilator settings (pressure support, peep, tidal volumes, fi02) or even mode after independent analysis of a blood gas. They’d also autonomously change inotropic/vasopressor support rates or give fluid bonuses after independent analysis of invasive cardiac monitoring (cardiac index, cardiac output, SVRI etc. This is on critically unwell, very fragile, very friable people. I didn’t work on the wards for long but there wasn’t anything that struck me as having as much responsibility as that. ED is a different beast entirely.

I’ve said up thread that we are all working incredibly hard, and that I don’t think we are necessarily working harder than anyone else. And yes in some respects it’s just a different skill set and no, I couldn’t look after 12 patients. I’d have a meltdown after two hours.

When I trained ward nurses during the pandemic they spoke about how amazed they were about our level of knowledge. I’ve heard the same from some ward nurses who came down pre pandemic for exposure. So I’m not just pulling it out my ass.

It’s also reflected in the enhanced pay rates bank and agency nurses get when they are ICU trained.

Thank you for all you do. My next door neighbour is an ICU nurse and an absolute hero.

@TheBobRoss i think it would be subject to way too much abuse and I don’t know how that could be policed.
But I do see why people would want the option, definitely

❤️

@Pinkplasticbathcup I'm an ICU nurse too of many years experience and you explained well how different crit care nursing is.
I worked on a busy medical ward for 5 years after qualifying. Looked after a bay of 8 or 9 patients and if in charge 20 odd patients. In my experience it was more about time management, being organised, delegating care appropriately and picking up on deteriorating patients. Back in the day we didn't have NEWS so far more dependence on your own clinical skills/ judgement.
ICU patients are so much sicker. Oxygen levels can drop to dangerously low levels randomly and the patient may need immediate manual ventilation, suctioning etc. No doc necessarily around. Equally we can give fluid boluses if patient is hypotensive, supplement electrolytes, start CPR and defibrillate. We routinely perform dialysis. Much is nurse led on the basis of our observations and junior docs often are less experienced.
Funnily enough during Covid we did care for several level 3 patients, 1:1 nursing went out of the window. Equally non ICU trained nurses were dragooned onto our unit with 6 hours training. Massive admiration for them !
Personally AfC was the biggest setback and did nothing for morale !

@Pinkplasticbathcup

You haven't offended me, it was just a question. As per the thread.

I've said, it is highly skilled and probably does deserve a supplement.

But most nurses deserve a higher wage.

Band 5s on wards are routinely left in charge of the whole ward. 2 nurses for 30 pts in most cases. It's a huge amount of responsibility. They are responsible for all aspects of the pts care, for escalating any concerns. Even for discharging pts now.

And of course they initiate cpr and defibrillate.

Whilst I respect the level of skill and knowledge required to work in ITU and appreciate its not for everyone I disagree it's 'better'

Just different

Thank you, that is extremely helpful, am going to read and absorb. really appreciate you taking the time to make such a thoughtful response

What did you go into?

I went into the private sector after my last NHS job of a training post within crit care.

I would highly recommend practice development, training and educating the next generation of ICU nurses was such fun.
It is of course a very practical art so I still got to work on the clinical shop floor with nurses I was training and got to care for patients. Best of both worlds.

What I witnessed during covid though, broke me.
Never have I experienced burnout, never have I been so utterly traumatised every minute of every hour that I spent in that place, and as you know, we see some horrific things ordinarily.
So well used to coping and cracking onwards.

Now after over 20 years in the NHS, I have found calm and peace in my work.
Cant let go though, still do occasional bank shifts and absolutely LOVE it again now.

It’s a pleasure and a privilege to be a critical care nurse. 😊

Every educated person, having read your thread, having watched another suffer, as I have, in war, in civvy life, in age, would know (Phase 1) we are all capable of expressing the circumstances (Phase 2) where we would want to progress to assisted suicide (Phase 3).

Like a Will that can be rewritten or to which a codicil can be added. Why not express how you want to die in life? Why should we attach so much importance to chattels and premium bonds through Wills. It’s like our assets are more important than our souls.

I’m a great believer in not consuming too much resources in old age. The problem is in the West we do exactly that, in spades.

I worked on the wards with ‘awake’ patients and hated doing shifts in itu as didn’t like looking after intubated patients. My friend worked in itu and couldn’t stand patients who were alert, orientated and verbal, she liked her 1:1 in itu where she felt more comfortable. Thank goodness there are all types of nurses!