The Making and Life of a Registered Nurse in the Era of COVID-19: Chapter Nine–My Life as an Intermediate Care Nurse

Nurse Talking To Senior Female Patient In Hospital Bed

I have always been able to get back up on my feet when I get knocked down, so I was not in the least bit discouraged by their decision to re-do the lower management in our hospital, it is after all was their prerogative. I found their action to be ill-advised, but remember the Peter Principle, it doesn’t always have to make sense.

This shake-up gave me the golden opportunity to test the critical care waters again. I asked for an interview with the ICU Director and was granted it. The nursing director liked what she saw and agreed to hire me to the ICU after I completed my eight week critical care course. However, there was a stipulation. I had to agree to work in the IMC for six or so months until they could hire more nurses. I, having no real choice readily agreed to this condition.

To start with I want to include the definition of the term. Intermediate nursing care means the provision of nursing care services, health-related services, and social services under the supervision of a licensed nurse to patients not requiring 24-hour nursing care. Another more complete definition is as follows: Intermediate nursing care means a basic care consisting of physical, emotional, social and other rehabilitative services under periodic medical supervision. This nursing care requires the skill of a licensed nurse for observation and recording of reactions and symptoms, and for supervision of nursing care. Most of the residents have long-term illnesses or disabilities which may have reached a relatively stable plateau. Other residents whose conditions are stabilized may need medical and nursing services to maintain stability. Essential supportive consultant services are provided in accordance with these regulations.

Taken from google search result on IMC.

Job Summary

Independently assesses, plans, implements, and evaluates the nursing care of patients from admission through discharge. In collaboration with the patient and family, provides theory-based professional nursing care and coordinates care delivery with the physician and other members of the healthcare team.

Taken from google search result on IMC.

The class was a combination of clinical, classwork and self-paced computer courses. The time flew by quickly. I finally finished my course by passing the final exam. To get me acclimated to the IMC floor I was given a couple of weeks of orientation. I ended up working there for eight months. I want you to know that they were the longest eight months in my life. I don’t know how nurses work their entire career in that department. I think it is the hardest department in the hospital. The nurse routinely has four to five critical patients to care for. In many hospitals, this also means that they have to care for patients with tracheostomies and are on ventilators. They also have either nasal gastric tubes (NGT) or gastric tubes or peg tubes where they receive enteral feedings. They are also incontinent of stool and urine, so they are total care patients, albeit stable. You thankfully are not primary care, which means that you do get help from CNAs. The workload, however, is backbreaking to say the least.

Since the department is intermediate in nature, you can receive upgrades and downgrades plus admits from the ER and direct admits and transfers from other facilities and doctors offices. You can also discharge your patients to their homes and transfer your patients to other facilities, as well as having them possibly code on you. It is a rough job and one that I think is thankless. Since you are not ICU, you don’t really get the respect that you deserve, and the burnout and turnover rate is the highest of all the nursing departments. Right or wrong, they have added many new non- titratable drips to the list of tasks that you have to deal with. Anything that requires every two-hour activities or monitoring is fair game for this department, which means you can do glucose finger sticks every two hours, pass pain meds every two hours and the list just goes on. So when not only my agreed upon six months flew by and two more months for good measure also evaporated, I had enough.  After the said eight months went by, I approached my boss about the agreement that was previously made. Unfortunately, the person that hired me no longer worked there. So I had to do some gentle reminding and just a little bit of arm twisting. While they did eventually say yes, they insisted that I take the ICU class over again. I adamantly refused and said that this had not been part of the original deal, so they acquiesced and I was transferred to the ICU where I have worked till just recently.