I am a proud, critical care nurse, and I have been in that specialty for the majority of my nursing career. Over the years I tried different areas to give them the benefit of the doubt, and I’ve worked anywhere from a rehabilitation center to hospice. But I’ve always gravitated back towards intensive care. I suppose it just suits me.
Over the years I have been approached by more than a handful of nurses who ask about critical care, and they’ll bounce the idea of them trying it out with me. It typically goes something like this:
“I’ve been thinking of becoming a critical care nurse. I’d love to just have two patients. I’m just so tired of the hectic pace of ________ (insert specific field).”
Honestly, I’m always happy when a nurse shows interest in my favored area. We are always on the lookout for a fresh new recruit after all, but there is that part of me that raises a brow. I am reminded of the Spaniard from Princess Bride, and I want to reply, “I do not thinka it means what you thinka it means.”
While dropping from a patient assignment number of six to an assignment of two sounds fabulous, there’s a bit more to consider. Sometimes you even get to have just one patient, and that’s where the fun really begins.
In critical care you might enjoy being in the room with your single patient, but I would suggest taking it easy on the water since you will be unable to leave that patient’s side. The machine inserted in their body to help their heart pump blood requires your constant observation. But you won’t even notice not getting a potty break or lunch break. You’ll be far too busy recording hourly vital signs, hourly abdominal pressure, hourly central venous pressure, cardiac output, and such.
In between that you’ll stay occupied obtaining hourly blood sugars, hanging six different antibiotics, and constantly titrating dangerous cardiac medications to sustain blood pressure and heart rate within parameters that are compatible to life.
All the while don’t forget simple tasks like controlling pain, sedation level, suctioning of endotracheal secretions, and assisting with bodily eliminations and bathing. No, there’s no nursing assistant to help with this.
You’ll be kinda busy so hopefully they won’t try to die on you.
If you don’t have this one patient, you’ll be gifted with two. Other than a balloon in their aorta your two patients may likely require all above interventions plus a trip down to CT. They’re all full codes, by the way.
Okay, so I’ll admit it’s not always crazy. Sometimes you get a pretty good patient, and you find yourself retrieving water or walking someone down the hall. That’s pretty awesome, right?
But I ask this. Have you ever seen a duck gliding across a pond? They seem so motionless as they maneuver through the water, and only small ripples are even glimpsed to let you know they’re moving. What you cannot see are the frantic kicks below the surface. Critical care is kind of like that.
Critical care patients are like a smoking volcano, and there’s no way to know when or if it might erupt. Sometimes you see the build-up before it explodes, but sometimes you don’t. Sometimes you don’t see the frantic kicks trying to keep your patient above water, but you know they’re there.
This is why a patient is in critical care, and if you’re a critical care nurse you understand that at any moment, often without warning, your patient may crash. Their vitals will plummet, their breathing will become distressed, and they will code.
Every moment spent in critical care is spent in a mindset of watchful anticipation, until it is not. Then it becomes action. Life-saving, fluid action.
So even if you have had a good day thus far you are always prepared for it to decline quickly. Sometimes it doesn’t. But often times it does.
Critical thinking is a requirement, and critical thinking requires being able to see the forest despite the trees. Patients surrounded by a dozen monitors and alarms sounding still need to be treated for pain. A smiling, talking patient can still be circling the drain. Even with everything going on with an intensive care patient, low blood sugar is still a frequent cause of problems. And you always still revert back to your ABCs.
I’m grateful for all my MedSurg and floor nurse co-workers. They do the job I cannot do! I’ve worked MedSurg before, and I can tell you that having six or seven patients is crazy, busy. It’s hectic. But having two is no less hectic. It’s just a different kind of busy.
Often times it seems like the grass may be greener on the other side, but if my time in nursing has taught me anything it is this; nursing is hard no matter where you work. No matter what specialty area you are in you will be required to intervene for the life of your patient. No matter where you work you will be expected to do more than you feel like you are physically, mentally, and/or emotionally capable of achieving. This is the life of a nurse.
I know on my end that being a critical care nurse is like Forrest Gump’s box of chocolates. You never know what you’re going to get. But if the above doesn’t scare you, and you can focus on multiple issues in a high stress environment, then we’d love to have you. If you’re interested in joining my crew come on down. We’ll find something for you to do for sure.