Starting my shift as a critical care nurse

Scott

Faculty: Health, Education, Medicine and Social Care
School: School of Nursing and Midwifery
Course: BSc (Hons) Adult Nursing
Category: Nursing and midwifery

7 May 2019

My day starts with a coffee because, let's face it, it makes the morning that little bit easier. I wait for the allocation to arrive and check which bed space I have been allocated to today. Enthusiastically, after the caffeine has entered my bloodstream, I head to the first handover. The nurse in charge, from the previous shift, appears, looking bedraggled and worn out after their 12 hour shift, and briefly summarises all the patients on one half of the unit. After this, the safety messages are read out. These are usually something about ensuring that we are adhering to medication policies, or announcements regarding equipment issues.

After this, the real fun begins! We walk to the bed space and take handover from the previous nurse. They always look pleased to see you, as it means that they are heading home and to bed. We go through the entire patient history, review their blood results, observations and medications. It’s a lengthy process but it’s essential to ensure that things are not missed. After this is over, I bid them farewell and they get to leave.

Now, first things first. The most important part of my day is the patient assessment and my safety checks. If the proverbial hits the fan later on, I want to know that I have fully prepared for anything and that there is equipment available to manage the situation. This means intravenous fluids and emergency airway and breathing equipment. Proper preparation prevents poor performance. In nursing, this could not be truer. If you are unprepared for an emergency, this could lead to disastrous consequences for your patient. On the flipside, having the right equipment to hand just prior to a major incident can be the difference between life and death.

Assessment skills are the key to being a good ICU nurse. I assess my patient using an ABCDE approach, others use a head-to-toe. It doesn’t matter how you do it, what matters is that things are not missed. A good assessment will notice any little changes in the patient condition which can mean that a treatment can be initiated early and potentially things can be dealt with before they escalate into anything major.

I check their Airway, is it clear, does it make funny sounds, is a tube helping them to breathe? I then move onto looking at their Breathing. I use a stethoscope and listen to the sounds of their breaths, I watch them, checking if they are taking lots of breaths or are they working hard to breathe? Next is Circulation. Are they warm, what rhythm is their heart in, how fast is it beating, are they on medications to support it? Onto Disability. Are they capable of a normal conversation, are they confused, are they sedated, do their eyes react to the light? Finally, Exposure. This covers everything else; wounds, drains, lines, pressure sores, the huge puddle of blood under the sheets (true story!). This might sound like a lot of work but this has all taken about 10-15 minutes tops. A nurse can think about so much at the same time that it would make your mind boggle.

So, I’m about 45 minutes into my shift and I have taken handover and fully assessed my patient. The likelihood is that I have probably drawn up a couple of medications to administer, carried out some studies on the patient’s heart and taken some bloods as well but I didn’t want to blow your mind with my entire routine!

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