A day in the life of an ICU Nurse

So imagine! caring for a patient who is a 68-year-old woman with history of  diabetes mellitus and hypertension, and was rushed to emergency department by the family members with complaints of profuse sweating and altered level of consciousness. On examination, found to have raised blood sugar levels of 527mg/dl, positive for urine ketones and altered arterial blood gas report. Patient was stabilized and later shifted for further observation. Now since patient already lies in a high risk category and is vulnerable…………. Where do you think patient would have been shifted?? Exactly, an Intensive Care Unit(ICU).

surgeon using monitor in operating room
Nurse using monitor in operating room

An ICU is a specialised unit of the hospital that provides comprehensive and continuous care for critically ill patients. ICU consists of patients who are either acutely or chronically ill and would require specialized treatment and care. Patients admitting to ICU can be critically ill patients, planned admissions but sudden deterioration of health, following a surgery or unexpected admissions after a road traffic accident. The main purpose of providing intensive care is health restoration. Some patients stay in for longer duration, until they recover or until they pass on.

Critical care nurses working in ICU are given patient assignment based on their competency levels and the acuity of patients. It means that a nurse who is more competent would get a critical patient as an assignment. Working in an ICU can be challenging and stressful at the same time.

ICU teams are multidisciplinary, consisting of critical care nurses, doctors and specialists (Dietician, physiotherapist, pharmacist, technicians) trained to provide care to the patients. The whole team works in coordination with each other.

Specialities in ICU

There are many specialities within ICU that you should be knowing. These include:

  • Cardiac ICU
  • Neurology ICU
  • Trauma ICU
  • Burn ICU
  • Paediatric ICU
  • Neonatal ICU
  • Medical ICU
  • Transplant ICU (Kidney, Liver, Heart)
  • Surgical ICU
Roles and responsibilities of an ICU nurse

Critical care nurses need to be well equipped with proper training to handle patients more appropriately. ICU is a battle ground for life and death, so the nurses are expected to come prepared. A lot depends upon the choices they make and the decisions they take. Therefore, Nurses needs to be accountable regarding their patients. In case you make up your mind to work in an ICU, these are some of the responsibilities you will be expected to perform

  • Monitoring, recording and reporting of the vital signs of critically ill patients
  • Routine head to toe assessment and documentation
  • Administering of medications and fluids as per doctor’s instructions
  • Monitoring of patient’s intake and output
  • Sample collection and sending routine investigations
  • Monitoring diet and nutritional needs of the patients
  • Prevention of pressure ulcers and proper care of wounds
  • Proper storage and utilization of ICU equipment and devices
  • Assisting in bed-side procedures with the doctors
  • Identifying patients at risk for complications
  • Following patient treatment plan 
  • Consultation and coordination with other healthcare team members
  • Handling and managing code blue status
  • Caring of pre and post-operative patients
  • Performing and providing BLS and ACLS protocols
  • Assessment of patient and family needs
  • Education and counselling to the family
Qualities of an ICU nurse

Critical care nurses are specially trained to care for the patients admitted in an ICU.  They usually require higher level of competency in comparison to nurses working in other areas of the hospital. 

Mother And Daughter With Nurse In Intensive Care Unit
Nurse making comfortable to mother in ICU

ICU nurses needs to be proficient in a wide variety of procedures especially advanced nursing skills. Intensive monitoring and closed observations are the prerequisites of ICU patients. Even though the nurse patient ratio is usually 1:1 or 1:2, still it can be stressful being an ICU nurse. ICU nurses needs to be specialized in the following skills 

  • Strategic planning in delivery of routine care 
  • Organization of work
  • Time management
  • Close observation and monitoring
  • Ability to identify complications in the early stage itself
  • Dedication to acquire new advanced skills
  • Critical thinking
  • Excellent communication skills
  • Coordination with other members of the team
  • Quick decision making skills
  • Compassionate and empathize with patients and family
  • Certifications such as BLS/ACLS/critical care nursing 
Challenges of an ICU nurse

As discussed earlier, working in an ICU can be challenging and stressful at the same time. The nursing care provided to the patients contributes a lot towards the improvement or deterioration of the patient’s condition. ICU nurses are required to remain completely focused throughout their shift and thus ensure patient safety. Since the nature of work in the ICUs can be complex and demanding it may leave the nurse fatigued most often. 

Nurses putting in so much physical efforts at work, can experience burnouts as well. Exhaustion, irritability and loss of job interests are some symptoms of nurses’ burnout. 

Rewards of Being an ICU Nurse

Although, there may be a significant number of challenges faced by the critical care nurses, it’s always a rewarding experience to see to your patient improve and being moved out of the ICU. Critical care nurses are considered to be highly competent when compared to other nurses of the hospital. Constant learning, developing interpersonal relationships with patients, impressive levels of patient’s accountability and career growth opportunities are some of the advantages of being an ICU nurse. 

There is no doubt about the fact that ICU nurses are always high in demand. One of the vital element when looking out for career growth and opportunity is your level of experience. Critical care nurses need to set a bench mark of minimum of 5 years. Once you smash that 5-year mark, you will have the experience desired to be a viable contender for other positions and you’ll be considered seasoned. Meanwhile, you may also continue to resume your education and certification programs. In-service sessions, continue nursing education and certification programs helps in building up competence, self-confidence and upgradation of knowledge.

With experience, good performance, and continuous education, you can move to other settings or may uphold more responsible positions.

What should the COVID-19 pandemic remind Nurses about Healthcare Associated Infections?

Healthcare-associated infections i.e. HAIs only usually receive public attention when there are epidemics. The situation is no different with rising hospitalizations due to COVID-19.

Although often hidden from public attention, the very real endemic, the ongoing problem is one that no institution or country can claim to have solved, despite many efforts. 
 Hundreds of millions of patients are affected by healthcare-associated infections worldwide each year, leading to significant mortality and financial losses for health systems.

As per the World Health Organisation,

  • Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one healthcare-associated infection.
  • While urinary tract infection is the most frequent healthcare-associated infection in high-income countries, surgical site infection is the leading infection in settings with limited resources, affecting up to one-third of operated patients; this is up to nine times higher than in developed countries.
  • Newborns are at higher risk of acquiring healthcare-associated infection in developing countries, with infection rates three to 20 times higher than in high-income countries.

The main solutions and perspectives for improvement identified by WHO are:

  • Identifying local determinants of the HAI burden.
  • Improving reporting and surveillance systems at the national level.
  • Ensuring minimum requirements in terms of facilities and dedicated resources available for HAI surveillance at the institutional level, including microbiology laboratories’ capacity.
  • Ensuring that core components for infection control are in place at the national and healthcare setting levels.
  • Implementing standard precautions, particularly best hand hygiene practices at the bedside.
  • Improving staff education and accountability.
  • Conducting research to adapt and validate surveillance protocols based on the reality of developing countries.
  • Conducting research on the potential involvement of patients and their families in HAI reporting and control

Keeping this in mind, our nurse educator Ms. Manisha Saklani attempts to throw some spotlight on Healthcare-Associated Infections in this extensive module from the point of view of a Nurse and her pivotal role & responsibility in its prevention.

Note: The video is just a 3 minute peek into the full module on HAIs where Manisha talks about the definition, factors that increase the risk of HAIs and it’s various types. To get access to the full module on HAIs write to us at: info@bodhihealthedu.org