September 6, 2024 • 11 mins
Part 4 of 5 ~ A Realistic View Into Nursing Areas: ICU
In this episode, I focus on the Intensive Care Unit (ICU) as a part of the five-part series that gives you an idea of what different areas of nursing are like. Each episode will challenge you to think about whether that particular area would be a good fit for you. I share both my positive and my negative experiences with the goal of helping you find your 'fit' in the nursing field. The reality is that everything doesn't fit everybody.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
All right. Hey, now we're going to start getting into a little bit more into the series. As
(00:10):
I mentioned before, some of my paramedic to RN friends, we were talking about how we didn't
have a really good accurate view of nursing before we became nurses. And we all kind of
moved around into different units before we found our fit. Some of us still haven't found
it. But for me, I was kind of in that boat and I moved around from a lot of places from ED,
(00:34):
step-down, critical care, surgical services, endoscopy, care coordination, and case management.
So I just wanted to kind of give you my experience and my insight on these different units. So then
that way, when you're making your choice early, before you even get into nursing, you can kind
of get a good idea of where you may find your fit. So welcome to my podcast. So finding your fit,
(01:05):
I think is probably as I was going through these different areas of nursing, I think that's probably
what the theme is, because not everything fits everyone. Like for example, step-down didn't
fit me, I'll be honest with you. And it wasn't because I just didn't think I was too good for
(01:27):
step-down. It was just that from what I know and what my mission is, I just didn't feel like it was
a good direction for me to head. I felt like I was wasting time. So I wanted to kind of talk to you
today about the intensive care unit. Then we call it the ICU. And for paramedics, some paramedics
(01:53):
enjoy the ICU, some didn't like the ICU, some would rather prefer the ED over the ICU. But now
I have found a trend that usually my friends that come from critical care transport, they pretty
much like the ICU environment because that's where they came from, usually the critical care
(02:15):
medics. And unless you have that background, the ICU could be a really steep learning curve,
I'll be honest with you. I know it was for me. So what I would like to do is kind of and share
with you what the ICU entails. ICU is usually broken down into different units. You have
(02:37):
different varieties of ICUs. It's really based on a medical issue to have at the time. You have the
medical ICU, which we call the MICU, the surgical and trauma ICU, sometimes referred to as the
CICU. You have your cardiac ICU, which is the CICU, and you have the cardiothoracic ICU, which is the
(02:59):
CICU, and you even have the NICU for the neonates. But my experience is from the CICU and the CICU.
And the workflow was exactly the opposite of the EDs, which where they were less patients,
(03:20):
but they was way more involved. Usually your ratio is one to two or one to one, especially
like if you have an ECMO patient. Usually your work floors, you have shift responsibilities and
you have certain things that's required per hour. For example, it requires a lot of charting,
(03:40):
especially on devices. So some of the shift responsibilities, you may have to save the EKG
strip to the patient's chart. You may have to ambulate your patient three times a day. You
may need to get a flat CVP at 4 o'clock AM and 4 o'clock PM. And also, respiratory may come two
(04:01):
times a day for oral care and suctioning, but anything outside of that, then you have to chart
that. You have to do it and chart it. So every hour, usually you want to get vitals. You want
to get even to include your central venous pressure, which is called your CVP, or
the numbers to come off your swan or pulmonary artery calf. You want to get your INOs,
(04:28):
like your chest tube drainage. If it drains over like a hundred mils an hour,
you may need to let the intensivist know. Also devices, devices like CRRT, which is
continuous urinary replacement therapy. It's like a dialysis, but it's for dialysis for patients
(04:49):
that are too sick to sit up in a chair. It's continuous. It's really slow. So instead of
hemodialysis, being able to take off, take your blood and filter it through, the CRRT is much
slower and it's continuous. Your VAD patients, you want to make sure your patients with your
(05:14):
ventricular assist devices, you want to chart those numbers and also all your ECMO numbers every hour.
Also, every other hour, if you might want to record your RAS, if they sedated, but also remember you
have your assessments at eight, 12 and four, and every four hours you want to chart your SVR,
which is systemic vascular resistance. And also your IV assessments, which is you want to do your
(05:39):
heartlines and central lines as well as your peripheral IVs. You also have electrolyte replacement
goals. So that's typically how your workflow can be. It's really busy, but most of the time,
like I said, you're doing a lot of charting and it's totally opposite whether in the ED you was
running around doing a lot of tasks, a lot of tasks, flipping patient, patient to patient.
(06:03):
This one, you have this patient and you're strictly monitoring this patient for different
things that can happen that can make the patient get worse. If the patient gets worse, then either
you have a protocol on what you need to do or you need to notify the intensivist. So the environment,
I found the environment really quiet, high stress, but a little sad. I've had patients,
(06:29):
like I had a patient that had a bowel necrosis and she was alert and oriented and just knowing
that she would die within the next four days because it was inoperable, the surgeons decided
not to. And just talking to the husband to try to do all they could do and the daughter,
(06:50):
it was just really taxing. And sometimes that stress, it just kind of wears on you.
And sometimes you take it home and the ED was different because I moved around so much,
it was so fast paced, I was exhausted. But with the ICU, I just found like you can kind of sit
and you can kind of soak into it and it kind of sticks with you. My hours, it's the same,
(07:13):
it's three 12s and also being on call. But I do think that for a paramedic, there's some really
good advantages to going into the ICU. And one is you're going to learn a lot. That's a good
positive. Especially when it comes to devices and medical terminology, because you get really deep
(07:34):
in intensive care. Whereas before, usually in paramedic, you hear on cardiac preload and
afterload, but when you start getting into things to understand what afterload really means and
systemic vascular resistance and get into your, your, you know, your part of your,
(07:58):
your numbers and your wedge pressures and your, you know, and your central venous pressures and
preload and you, and what medications affect what and, and titrating
your different pressures and knowing what pressures to run and which pressures affect
different things, what medical effects, arterial and the venous system, it can get a little
(08:22):
overwhelming, but as you stick with it, it starts to sink in, you start to understand more. So keep
in mind, that's a steep learning curve and your paramedic knowledge helps, especially if you come
from a critical care paramedic background, then it's going to be a regurgitate of things you are
already know, but just more on a deeper, deeper level. But your assessment is golden as a paramedic
(08:45):
because you can, you know, when your patient is declining. And to me, I felt like there's a
little bit more autonomy in the ICU than it is in the ED, because you typically have a protocol that
you can work from before you contact the intensivist. Also, the experience, if you want to become a
if you want to become a flight nurse or critical care transport nurse, or even if you want to go to
(09:10):
CRNA school, you know, usually, ICUs are a requirement, especially for, for CRNA. You know,
they want you to have at least one year in the ICU because as a CRNA, if you manage in patients in
the ED, I'm sorry, in the OS, if you manage in patients in the operating room, then you have to
be able to read numbers and you have to have a critical care, a good solid critical care background.
(09:32):
So that's some of the positives. I think one of some of the negatives is you have to learn a lot
in a very short time, especially with devices and terminology being in the ICU. And it really
depends on which one, for example, being in a MICU, you may have a different style patients,
maybe a patient may be septic or versus, you know, in this cardiothoracic ICU, your patient have a
(09:58):
your patient have a swine gas cath and you have to be able to understand PA numbers and,
and be able to read those numbers off that cath, or you may have an ECMO patient versus a patient
that may be in the NICU specialized dealing with neonates. So wherever you go, the learning curve
can be quite steep. And also, you know, when you manage in these patients, these patients have
(10:21):
multiple tetradable drips. Your head has to be in the game. You know, you can't be sitting at the
desk if you don't have nothing to do and be on your phone, you really have to keep an eye on
these patients because they can start crashing in a heartbeat. And in the critical care arena,
something just as simple as not keeping your patient warm can have a detrimental effect
(10:44):
on your patient outcome. So, or just because you let the patient potassium because you wasn't
paying attention to your, your electrolyte replacement goals and that potassium dip down,
you wasn't paying attention, looking at labs, then that can have a really bad effect on,
on your patient. Hypokalemia is not good for your patients. So hopefully that can give you a little
(11:10):
bit more in depth on, especially being in the ICU and give you a little bit more insight because
maybe some of you guys may say, Hey, I want to go to the ICU, but not know what that entails.
So hopefully I kind of gave you a little bit more in depth information. So I thank you guys
for joining me and I'll see you guys next week. Take care. As always, hey, make sure you guys
(11:36):
follow me on Instagram at paramedic2rnfo. Remember that number too.
All right. Hey, now we're going to start getting into a little bit more into the series. As
(00:10):
I mentioned before, some of my paramedic to RN friends, we were talking about how we didn't
have a really good accurate view of nursing before we became nurses. And we all kind of
moved around into different units before we found our fit. Some of us still haven't found
it. But for me, I was kind of in that boat and I moved around from a lot of places from ED,
(00:34):
step-down, critical care, surgical services, endoscopy, care coordination, and case management.
So I just wanted to kind of give you my experience and my insight on these different units. So then
that way, when you're making your choice early, before you even get into nursing, you can kind
of get a good idea of where you may find your fit. So welcome to my podcast. So finding your fit,
(01:05):
I think is probably as I was going through these different areas of nursing, I think that's probably
what the theme is, because not everything fits everyone. Like for example, step-down didn't
fit me, I'll be honest with you. And it wasn't because I just didn't think I was too good for
(01:27):
step-down. It was just that from what I know and what my mission is, I just didn't feel like it was
a good direction for me to head. I felt like I was wasting time. So I wanted to kind of talk to you
today about the intensive care unit. Then we call it the ICU. And for paramedics, some paramedics
(01:53):
enjoy the ICU, some didn't like the ICU, some would rather prefer the ED over the ICU. But now
I have found a trend that usually my friends that come from critical care transport, they pretty
much like the ICU environment because that's where they came from, usually the critical care
(02:15):
medics. And unless you have that background, the ICU could be a really steep learning curve,
I'll be honest with you. I know it was for me. So what I would like to do is kind of and share
with you what the ICU entails. ICU is usually broken down into different units. You have
(02:37):
different varieties of ICUs. It's really based on a medical issue to have at the time. You have the
medical ICU, which we call the MICU, the surgical and trauma ICU, sometimes referred to as the
CICU. You have your cardiac ICU, which is the CICU, and you have the cardiothoracic ICU, which is the
(02:59):
CICU, and you even have the NICU for the neonates. But my experience is from the CICU and the CICU.
And the workflow was exactly the opposite of the EDs, which where they were less patients,
(03:20):
but they was way more involved. Usually your ratio is one to two or one to one, especially
like if you have an ECMO patient. Usually your work floors, you have shift responsibilities and
you have certain things that's required per hour. For example, it requires a lot of charting,
(03:40):
especially on devices. So some of the shift responsibilities, you may have to save the EKG
strip to the patient's chart. You may have to ambulate your patient three times a day. You
may need to get a flat CVP at 4 o'clock AM and 4 o'clock PM. And also, respiratory may come two
(04:01):
times a day for oral care and suctioning, but anything outside of that, then you have to chart
that. You have to do it and chart it. So every hour, usually you want to get vitals. You want
to get even to include your central venous pressure, which is called your CVP, or
the numbers to come off your swan or pulmonary artery calf. You want to get your INOs,
(04:28):
like your chest tube drainage. If it drains over like a hundred mils an hour,
you may need to let the intensivist know. Also devices, devices like CRRT, which is
continuous urinary replacement therapy. It's like a dialysis, but it's for dialysis for patients
(04:49):
that are too sick to sit up in a chair. It's continuous. It's really slow. So instead of
hemodialysis, being able to take off, take your blood and filter it through, the CRRT is much
slower and it's continuous. Your VAD patients, you want to make sure your patients with your
(05:14):
ventricular assist devices, you want to chart those numbers and also all your ECMO numbers every hour.
Also, every other hour, if you might want to record your RAS, if they sedated, but also remember you
have your assessments at eight, 12 and four, and every four hours you want to chart your SVR,
which is systemic vascular resistance. And also your IV assessments, which is you want to do your
(05:39):
heartlines and central lines as well as your peripheral IVs. You also have electrolyte replacement
goals. So that's typically how your workflow can be. It's really busy, but most of the time,
like I said, you're doing a lot of charting and it's totally opposite whether in the ED you was
running around doing a lot of tasks, a lot of tasks, flipping patient, patient to patient.
(06:03):
This one, you have this patient and you're strictly monitoring this patient for different
things that can happen that can make the patient get worse. If the patient gets worse, then either
you have a protocol on what you need to do or you need to notify the intensivist. So the environment,
I found the environment really quiet, high stress, but a little sad. I've had patients,
(06:29):
like I had a patient that had a bowel necrosis and she was alert and oriented and just knowing
that she would die within the next four days because it was inoperable, the surgeons decided
not to. And just talking to the husband to try to do all they could do and the daughter,
(06:50):
it was just really taxing. And sometimes that stress, it just kind of wears on you.
And sometimes you take it home and the ED was different because I moved around so much,
it was so fast paced, I was exhausted. But with the ICU, I just found like you can kind of sit
and you can kind of soak into it and it kind of sticks with you. My hours, it's the same,
(07:13):
it's three 12s and also being on call. But I do think that for a paramedic, there's some really
good advantages to going into the ICU. And one is you're going to learn a lot. That's a good
positive. Especially when it comes to devices and medical terminology, because you get really deep
(07:34):
in intensive care. Whereas before, usually in paramedic, you hear on cardiac preload and
afterload, but when you start getting into things to understand what afterload really means and
systemic vascular resistance and get into your, your, you know, your part of your,
(07:58):
your numbers and your wedge pressures and your, you know, and your central venous pressures and
preload and you, and what medications affect what and, and titrating
your different pressures and knowing what pressures to run and which pressures affect
different things, what medical effects, arterial and the venous system, it can get a little
(08:22):
overwhelming, but as you stick with it, it starts to sink in, you start to understand more. So keep
in mind, that's a steep learning curve and your paramedic knowledge helps, especially if you come
from a critical care paramedic background, then it's going to be a regurgitate of things you are
already know, but just more on a deeper, deeper level. But your assessment is golden as a paramedic
(08:45):
because you can, you know, when your patient is declining. And to me, I felt like there's a
little bit more autonomy in the ICU than it is in the ED, because you typically have a protocol that
you can work from before you contact the intensivist. Also, the experience, if you want to become a
if you want to become a flight nurse or critical care transport nurse, or even if you want to go to
(09:10):
CRNA school, you know, usually, ICUs are a requirement, especially for, for CRNA. You know,
they want you to have at least one year in the ICU because as a CRNA, if you manage in patients in
the ED, I'm sorry, in the OS, if you manage in patients in the operating room, then you have to
be able to read numbers and you have to have a critical care, a good solid critical care background.
(09:32):
So that's some of the positives. I think one of some of the negatives is you have to learn a lot
in a very short time, especially with devices and terminology being in the ICU. And it really
depends on which one, for example, being in a MICU, you may have a different style patients,
maybe a patient may be septic or versus, you know, in this cardiothoracic ICU, your patient have a
(09:58):
your patient have a swine gas cath and you have to be able to understand PA numbers and,
and be able to read those numbers off that cath, or you may have an ECMO patient versus a patient
that may be in the NICU specialized dealing with neonates. So wherever you go, the learning curve
can be quite steep. And also, you know, when you manage in these patients, these patients have
(10:21):
multiple tetradable drips. Your head has to be in the game. You know, you can't be sitting at the
desk if you don't have nothing to do and be on your phone, you really have to keep an eye on
these patients because they can start crashing in a heartbeat. And in the critical care arena,
something just as simple as not keeping your patient warm can have a detrimental effect
(10:44):
on your patient outcome. So, or just because you let the patient potassium because you wasn't
paying attention to your, your electrolyte replacement goals and that potassium dip down,
you wasn't paying attention, looking at labs, then that can have a really bad effect on,
on your patient. Hypokalemia is not good for your patients. So hopefully that can give you a little
(11:10):
bit more in depth on, especially being in the ICU and give you a little bit more insight because
maybe some of you guys may say, Hey, I want to go to the ICU, but not know what that entails.
So hopefully I kind of gave you a little bit more in depth information. So I thank you guys
for joining me and I'll see you guys next week. Take care. As always, hey, make sure you guys
(11:36):
follow me on Instagram at paramedic2rnfo. Remember that number too.
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