Sam: You are an Intensive Care ICU Nurse. Can you tell me about an average shift? You walk in the door… what happens next?
Olivia (ICU Nurse): On a morning shift, you’ll go and get allocated your patient. Sometimes you can get two patients; depending on the high acuteness of their illness. You have certain things that you have to check in your bay area. So, you have to check that you’ve got all the emergency equipment, that you’ve got all the ventilator and the drugs. You check that you have a resus [resuscitation] emergency kit, if something was to fail. And you check your trolley to make sure you have all the equipment you need for that shift.
Then you check your patient. You do a head to toe examination of your patient as a nurse. So, you check their GCS. You make sure that they know where they are. Check their pupils to make sure that they’re the same size. You check their strength, make sure all their limbs are moving equally. Then you listen to the lungs, make sure that their lungs are equal and they’ve got good ‘breath sound’ on both lungs. You need to ensure that you, as a nurse starting the shift can say, “Yes, I am aware of the state of the patient and I’m not too concerned anything out of the ordinary.” Or, if you are concerned, then you let the team know about something that you found during your assessment.
Then you just go through the day. You have a look at their medications that are due. The doctors will come around, at some point, and examine the patient and give a plan for the day. They might say that they want certain drugs given, or they want a drain taken out, or they want the patient to have a CT scan, or an X Ray of some sort. You plan your day as what the doctors have prescribed.
Then you have a layover at two o’clock where the evening nurses arrive. This is the transition from a morning shift to an evening shift. You hand over to that nurse, the same way the nurse handed over to you, and give them the plan for the day.
Sometimes there are ‘skills’ that you will need to do with the patient that require two nurses. So, you leave them till two o’clock when the evening nurse arrives so that you can do them together.
Sam: What’s an example of that?
Olivia (ICU Nurse): Taking out a chest drain. So, a lot of the patients that come into my ICU, have chest drains in. So, it’s a two nurse process. One has to pull the drain out and one has to pull the stitch closed together. The patient is a high risk of sucking air back into their lungs. So, it’s needing to nurses there to make sure the process goes slowly and smoothly. So, there is isn’t any risk of that.
Sam: What do you like about being a ICU nurse, specifically over other types of nursing?
Olivia (ICU Nurse): I like the routine and the non-chaotic side of my ward. If you’re quick enough and got things under control, it’s a very controlled environment. Compared to the general side of in ICU, which is not very controlled.
Sam: Why? Because people are in-and-out?
Olivia (ICU Nurse): Yes, people are in-and-out – it’s an overflow from ED. So, some patients are very dishevelled in their presentation. They have a lot of mental health issues. They might be coming down from drugs and not very compliant with your nursing care.
Sam: ED (Emergency Department) nursing must be frantic then, if there is an overflow unit in ICU for it?
Olivia (ICU Nurse): Yeah, it can be chaotic. If you were going to work in emergency, you never know what could come through the door next. One minute you could have one patient, then the next thing; you could have 20 patients. It’s a very chaotic environment. It’s not necessarily neat. There is also a lot of variety, someone will come in facing a life-threatening situation, then one minute later it could be someone who has a headache and they need some Panadol. There is a huge range. As a nurse you have to be very skilled in knowing what situations to take seriously and then which patients to send back on their way.
Sam: Your hospital is kind of renowned for ED being filled with people who are on drugs or in violent situations, under the influence of alcohol. In that situation, how does your nursing practice change?
Olivia (ICU Nurse): You still do the processes of your job the same as you would with any other patient. That’s the great thing about health system, it’s equal treatment and access to treatment. Though, you can’t tolerate violence or aggression.
Sam: Have you ever been in a situation where someone has been violent or aggressive?
Olivia (ICU Nurse): Yeah, absolutely. And we call a code black, which is one of the processes that you do in the hospital. It means the security team will get there within five minutes. Normally this puts the patient back in check; when three quite large security men come up and stand behind you. And they say to the patient, “We’re here to support her. So, if you don’t… You can leave.” The patient can leave at time if they want, unless they’re under the Mental Health Act.
But if they want to stay and be treated, then they have to be compliant with our care. And you should never ever have to tolerate violence or aggression towards yourself. It’s something that happens too often. And you can definitely walk away from the situation and say, “I’m not going to tolerate this as a nurse.”