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

Most people are familiar with what an intensive care unit (ICU) nurse does, but I don’t like to assume or take anything for granted, so I will spend a little time defining and discussing what their duties are.

The following description and details about ICU nurses was provided for by the website

ICU nurses or critical care nurses are highly specialized and trained healthcare personnel who provide nursing care to patients with life-threatening illnesses or conditions. They provide specialized experience, knowledge, and skills that patients need to survive or de-escalate care. ICU nurses are trained to make split-second decisions and act quickly when a patient’s status changes. Their primary work environment in the hospital is in specialized care units. Typically, ICU patients need a high level of care, and most of them are admitted to the hospital. 

ICU nurses work in challenging and complex fields in their nursing profession. They have the primary duty to provide lifesaving care to patients fighting for their lives. They are highly trained to provide exceptional care for patients who depend on 24/7 nursing care. A patient in ICU is often ventilated, intubated, and can be on several life-saving machines and medications. ICU nurses are at the top of their game and well-versed with all aspects of specialized care to restore their patients’ health and wellness. Some of the specific responsibilities of ICU nurses include:

  • Evaluating and monitoring of patient’s progress and identification of any sudden or subtle changes in the patient’s medical condition
  • Administering medications intravenously by injection or via gastric tubes
  • Delivering regular updates of patient’s progress to doctors, patients, and their families
  • Performing approved diagnostic or therapeutic procedures according to the patient’s clinical status
  • Responding to health emergencies when called upon and alert appropriate doctors
  • Evaluating patient’s laboratory data and vital signs to determine emergency intervention needs
  • Caring for patient needs throughout their recovery journey in ICU
  • Advocating for patients’ and families’ needs
  • Providing emotional support to patients and their families
  • Setting up and monitoring medical equipment and devices like medical ventilators, oxygen delivery devices, transducers, and pressure lines.
  • Assessing patients pain level and sedation requirements
  • Maintaining patient records

The following are the different types of critical care nurses: 

  • Postoperative care ICU unit nurses – These nurses work with patients who experience pain following surgery. They typically have exceptional knowledge of anesthesiology.
  • Pediatric ICU nurses – These nurses work in pediatric intensive care units and provide care to critically ill or injured children.
  • Emergency room ICU nurses – ER nurses work with patients that need urgent treatment. They work long shifts, usually up to 40 hours a week.
  • Neonatal ICU nurses – Neonatal nurses work with newborn babies who face a life-threatening disease or condition.
  • Cardiac care unit ICU nurses – These nurses work with the most critically ill patients. They boast of exceptional experience and education in the medical field.
  • Cardiothoracic ICU nurses – These nurses work with patients suffering from severe heart conditions. They handle a maximum of 2 patients.

I hope this brief description has helped to clear-up any confusion that there might have been or answered any questions the reader may have had on not only who ICU nurses are but what they do. Depending on the level of care required by the patient in the ICU, you can have a 3-to-1 ratio, with the ICU nurse caring for three patients or a 1-to-2 ratio, where the patient requires two ICU nurses to care for them, usually in the cases of a fresh open heart procedure. Though in a few cases, just after a patient coded I have required the aid of several ICU nurses for a brief while until they were stabilized.

Usually patients that require this type of care are unable to care for themselves, and in many instances they need help to breathe, and help sustaining their hemodynamic status, through the use of blood pressure supporting medications or drips. In some cases, they need hemodialysis around the clock which is commonly referred to as Continuous Renal Replacement Therapy or (CRRT). This requires the care of a specially-trained nurse in dialysis care and is 1-to-1 patient, which means that this nurse only has to care for one patient.

Working in the ICU can be a very rewarding experience, mainly because there is a level of autonomy not usually enjoyed by most nurses. A lot of the medications are ordered with ranges provided, so that the nurse can adjust these medications to keep the patients status stable. In most cases, the typical nurse has a single dose or very strict dosing that they can administer to the patient. We also have a little more latitude in holding medications due to the patient’s status, mainly because there simply is not enough time to call for additional orders or that the medical doctor has a higher level of trust and confidence that the nurse has the skill and knowledge to make some of these decisions without constant supervision. You also tend to develop closer relationships with not only the patient but the family as well. This is due to the fact that you have fewer patients to care for and have more time to devote to them. You also spend more time updating them on their loved ones condition on the phone. So even though many of the patients can’t communicate directly to you, you still have to have good communication skills.

Some nurses say they like being an ICU nurse because they don’t have to talk to their patients, well, this is nonsense because you, in many cases, spend just as much time talking to their family members either in person or on the phone.

ICU nursing usually appeals to those that are highly goal-oriented or those who enjoy tinkering. With many critical care medications, you can fine-tune a patient’s status just like you would tune a guitar or piano. By making small adjustments in their medications, you can alter their vital signs and breathing or you can affect the chemical balances of their circulating blood. Some patients are on continuous insulin drips, so you are effectively altering their blood chemistry in regards to the amount of circulating glucose that is present. In the case of CRRT, you are altering not only the volume of circulating body fluids, you are also making adjustments to their electrolytes as well. It is very rewarding to admit a new patient who is struggling and is in a very unstable condition and by the end of your shift you have in part stabilized them.

You also have to have a strong constitution because you will inevitably have patients die. It is just the nature of the job. Some people are just too sick to save, or it is their time. It is our job to help those individuals to die with dignity and to help the family get through those tough times. We also make arrangements for the transfer of the deceased patient to the funeral home. In some cases, when the patient suffers a neurovascular attack and becomes clinically brain dead, the rest of their body may still be healthy and the organs are viable. In these cases, the family may opt for their loved one’s body to be donated for organ procurement. As ICU nurses, we assist the organ donor staff in preparing the patient for organ harvesting. The death of one unfortunate person can save multiple lives. It is a very laborious task and in many cases requires two to three days to make arrangements and stabilize the patient.

Another benefit that most nurses don’t think about is that due to the reliance on other highly skilled nurses assistance often brings about closer relationships than would be typical on floors with less critical patients. In many cases, you rely on team nursing to bathe and clean up your patients. Since the patients are in critical condition or are heavily sedated they lose control of their bowels so they require frequent cleaning and because they are immobile they also require frequent turning to prevent the development of sores. These activities often require assistance of a second staff member. ICU nursing is primary in nature, which means that we have no CNA for assistance, so that other staff member is another ICU nurse, ergo more time is spent working and helping your colleagues.

The vast majority of the staff I worked with over the 12 odd years were stellar and were all hardworking. However, only a few stick out as being unique enough to warrant a section in my memoirs. Like I said, this has nothing to do with their lack of merit, it is simply a matter of available space. Over the course of my career, I have worked with hundreds, if not thousands of different individuals, so you can see my conundrum. I simply can’t discuss everyone, so if you don’t find your story in my memoirs, I am sorry.

The first nurse I want to talk about is a bit of a world traveler in her own right. She was fortunate enough to start out her career right out of college as a nurse which in Nevada is a fairly high paying position. She is just now closing in on her 30-year age mark and finally put her suitcases in the closet for a while to test the marriage waters. She has circumnavigated the globe and has visited and explored over 60 different countries, not to mention an untold number of island chains. While I don’t care for her shotgun and rapid fire style of travel, I do envy her the places that she has seen. I am close to twice her age and I have yet to break the 10 country mark. I guess, if I had not gotten married and divorced twice and had started off my career as a nurse maybe I would have been able to do more international travel. Unfortunately or fortunately, you can’t go back and do it all over again. Her early career choice has however, come with a heavy price tag. She has not even reached the 10 year mark in nursing and she is already getting burned out. She ended up resigning a few months before I did. I wish her the best in her career and in her new marriage.

The second nurse I want to discuss is one that I have developed a truly unique relationship with. This nurse is another young woman who is also closing in on the 30-year old mark. She also just quit from my hospital with the same malady… burnout. She is a truly a free spirit and does not have a spiteful bone in her young body. In an idle chat with her, I quite some time ago found out that she worked as a model to put herself through nursing school. So as you can most likely guess she became my model. I do shoots on average of two-three times a year with her. She also has over ten other photographers who she works with. I have been doing cosplay, glamour and nudes with her for over five years now. She is a consummate professional both in nursing as well in modeling. She is simply a joy to work with. Even though I don’t work with her in the medical environment any more, I still do the odd photoshoot with her. As a matter of fact, I have four more shoots planned with her. After which I will close up my studio and shift to other photographic subject matter. I hope she keeps up her nursing career because she is a wonderfully caring individual.

ICU nurses have been hit particularly hard by the COVID-19 pandemic, so much so that I want to devote a chapter just to this crisis.