I began my nursing career back in 1994 at the tender age of 20, soon after graduating from St. Clare’s Mercy Hospital School of Nursing in St. John’s. Jobs were scarce at that time, and a large majority of my classmates ventured on to the United States in search of employment.
I started out in a casual nursing position in acute care and medicine at St. Clare’s Mercy Hospital, and in 1998, I became a full time registered nurse in the Intensive Care Unit (ICU) at the Salvation Army Grace General Hospital.
I had two years at “the Grace” to get my feet wet, before the hospital closed in June 2000. I then entered the exciting, yet intimidating, world at the Medical Surgical Intensive Care Unit (MSICU) at the newly built Health Sciences Centre.
I thoroughly enjoyed my introduction to critical care at the old Grace hospital and decided I would “stick with it” for a while … that “while” has now turned into 17 years!
“It seemed that ICU had chosen me, more than I had chosen it …”
The Health Sciences Centre at that time was going through many changes to absorb the patients and staff of the Salvation Army Grace General Hospital. At this point in my career, I had six years of nursing experience, with only two being in critical care. This meant that in some ways, I still felt very “green,” and that the new MSICU at the Health Sciences Centre was overwhelming for me, to say the least.
This new unit was bigger, busier, noisier and sadder than what I was used to – but it seemed to be a controlled chaos. I do remember being instantly impressed by how smoothly things ran at the MSICU, and how well everyone worked together as a team.
Since my time at the MSICU, I saw many types of patients coming through the doors. Patients varied in age, ranging from 16 to 90. I was exposed for the first time to trauma and burn patients.
Fast forward to 2015: although many things are the same, change is constant in such a fast-paced environment. Under the umbrella of the MSICU, there are many types of patients critical care nurses care for with each day.
Nurses become a “jack of all trades,” so to speak, as we care for a wide-ranging group of patients who require care from obstetrics to oncology, and almost everything in between. Each patient requires different procedures, individualized treatments and assessments.
Occasionally, we care for the high-risk pregnant or post-partum patient. We deal with tremendously difficult situations where the mother, the baby, or both for example, have not survived. But, then, after all those heartbreaking cases, some of us are fortunate enough to take part of some of the most wonderful, joyous moments in patients’ lives.
We also learn from our patients. Sometimes we attend to trauma patients as young as 16 years old, which gives us experience with the pediatric demographic. These young people teach us how to communicate with them and their parents.
We have had patients of all ages who have had life altering traumatic brain or spinal cord injuries. Paraplegics, quadriplegics, amputations, sensory losses, skin grafting for burn patients, and the list goes on.
“You can never predict what you might be facing when you go in for your shift.”
We have also had a large number of cancer patients come through our doors, who have been in varying stages of their disease, whether it be after a complicated surgery, a reaction to treatment, or a change in their status. In conjunction with the oncology team, we administer chemotherapy when it is appropriate, and we support them though the most difficult task of battling both cancer and critical illness.
There are many times when the critical care areas have palliative patients. We often have to change gears from critical, lifesaving measures, to that of comfort care. End-of-life care is a painful, and often a daily reality of working in critical care. The focus changes from analyzing rhythms, mixing infusions and trips to diagnostic tests, to that of providing comfort to the patient, and as much support and privacy as possible to the family during the most difficult time.
“The emotional side of critical care nursing can be far more stressful than the physical care at times … thoughts of these patients stay with us long after our shift is over.”
Organ donation is one area that is closely tied to critical care. When a family is faced with the devastating news that their loved one is brain dead, for example, we support them as they make their decision to donate. The organ procurement team is a vital part of critical care, and together with their oversight, the bedside nurse plays a critical role in the many procedures that are required to ensure that a patient is a suitable donor.
We are very fortunate to live in a place of wonderfully generous people. The vast majority of families faced with this rare circumstance choose to donate, and the loss of their love one, gives life to so many other Canadians. The emotional component of caring for organ donors is one of the most bittersweet experiences I have ever known. I don’t think anything has made me more proud as a registered nurse or as a Newfoundlander, than to know how many families choose to donate just so another can live.
I have witnessed many aspects of critical care evolve over the past two decades, some of which are consistent with changes in modern-day society. Take, for example, mental health issues, a facet of critical care nursing that may not typically be associated with our group. We see a much higher number of mental health and addictions-related admissions compared to earlier times. In more recent years, I personally, have seen more overdoses, attempted suicides and crime-related injuries than ever before in my career, and dealing with these sensitive issues requires a lot of empathy. We also see increasing levels of delirium, where patients can be agitated and sometimes aggressive.
Another societal change that is affecting critical care, is the increased number of morbidly obese patients. With half of the population being either overweight or obese, naturally, many of our patients fall within this category. There have been many changes made over the years to accommodate this shift, such as an increase in specialized beds, lifts and diagnostic equipment.
Also in recent years has been the addition of long-term care beds for ventilated patients. Now, these patients can receive long-term care in a more appropriate and home-like setting. We also see ventilated patients who live out in the community, who are admitted back to the ICU from time to time – these patients are like part of our family. Critical care is more physically demanding than many people can even begin to understand. All of our staff who provide direct patient care are registered nurses. There is a great sense of teamwork and we always have each other’s back! Nobody is ever on their own, and we do our best to take care of each other, as much as we do for our patients.
There is something to be said for the type of bond that develops from sharing some of the most sacred, tragic and touching moments of peoples’ lives. We spend so much time side by side with our colleagues, and we support and counsel each other through both our professional and personal challenges. I can honestly say that some of my closest friendships have been built from time spent working together in the ICU.
Although the outcomes are not always happy in the critical care setting, I do have a feeling of pride in our department, and knowing that we provide the best care possible to those we serve, provides me with great satisfaction. There are times when patients come back to visit us after they recover, or we see them and family members years later in the mall and they remember us, hug us and call us “mighty mouse.” That makes it all worth it for me! ■
This story was written by Lisa Power, a critical care nurse with Eastern Health.