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.
ruthiespage says
yep! Spent five days there with BJ last fall. Don’t think I saw you sit except once, and that was to chart. Loved knowing you were there. You are an awesome nurse! and I appreciate all you do
brieann.rn@gmail.com says
Thanks so much!
Denise says
Now that’s the most awesome kind of compliment, Brie!! We both know that it doesn’t get and better than that!
April says
Being an ICU nurse myself, I know you relish every chance you have to sit down. Often times even charting is done standing up. Have you ever found yourself taking a quick two seconds to go to the bathroom, just so you CAN sit down? I have been an ICU nurse for 16 years. Through thick and thin, I can honestly say I still love what I do. I have only been reading your blog for a short time, but I have found you hit the nail right on the head on what it is to be a nurse, especially an ICU nurse.
brieann.rn@gmail.com says
Thanks so much. Definitely understand the bathroom break. Lol.
Kathy Nolan says
Thanks for once again saying all the things ICU nurses think and feel. It is like a complicated dance and we make it look easy but it is very complicated. Be prepared for the worst and be thankful for the best outcome with your patient. 36 years and counting
brieann.rn@gmail.com says
Thanks Kathy.
Mary says
This is so well written and so accurate, as a PICU nurse myself I can definetly relate, the duck gliding across the pond analogy is perfect. I also love how you recognize that nursing is hard no matter what type of nursing you do, I too appreciate my fellow nurses who work in all different areas of health care sand know that everyone is busy and working hard.
brieann.rn@gmail.com says
Thank you.
Nina says
If only they could give us more help so we can take a bathroom break or take a sip of coffee or water.
Rebecca Zimmerman says
As a long time critical care nurse I enjoyed your article. You did an excellent description of what it means to work in ICU.
Mary kay brown says
Perfect description! We had a family who just couldnt understand why we werent excited everytime their loved one needed suctioned etc until they saw us code the pt next door! Total change of attitude when they realized we knew when to get excited about things!!!
Lindsay roth says
You couldn’t have described this any better. Laughing about princess bride comment!!!! It definitely does not mean what you thinka it mean!! Love this writing, thank you for sharing.
brieann.rn@gmail.com says
Thank you.
Donna Burman says
Loved all your descriptions. After being a labor and delivery nurse for 32 years in a Level 3 perinatal center for 32 years, the thought of 1:1 or 1:2 nurse patient ratio was many times looked at by as easy work as well. As if we sat eating Bon bonds until the time of birth. If only… First every mom was at least 2 patients, and eyes neve and ears of a labor nurse were keenly used every second of every shift. Rewarding, but stressful and physically demanding. I have now traded those days for simpler act in same day surgery. It was my time to move on, but in my heart I live on as a labor nurse.
Tammy says
You described critical care to a tee. Thank you for letting others know what we do and how we love it.
brieann.rn@gmail.com says
Thank you.
Valarie says
Brie, I am a retired nurse who did a variety of units in my 40 years of nursing. 10 of those were in critical care, which I loved. I felt right at home reading your discription of what it is like to work there. I finished my career with OB, another misunderstood area. When a mom crashes, she and her baby have little time before disaster. Thank you for your wonderful writing. I enjoyed it.
brieann.rn@gmail.com says
Thank you.
Jonathan says
As a NICU dad I can tell you that no one appreciates critical care nurses more than we do. To watch their grace under fire as they repeatedly have both their tiny little patients desat at the exact same moment. Bringing one baby’s vitals back to normal while calmly instructing the other parents on how to do the same thing is a skill that you all have. On top of it all you do it with care and compassion while making us parents feel empowered in an environment that is quite frankly overwhelming.
We are forever thankful for all that you do in a seemingly effortless fashion.
brieann.rn@gmail.com says
Thank you for commenting and sharing.
Karen Sullivan says
An exceptional point of view in the ICU! However now with the healthcare transition, on most days you have 3 or maybe even 4 patients as they rotate your assignments to make short staffing work. You have no time for report as the patient is already rolling in the room. We all know an ICU gets their security from knowing the patient head to toe, labs, tests, allergies, etc… so we can critically think with all sources available. You now become an ER nurse who has no clue what to expect except that you won’t be transferring them to a more critical area when they crash… they are your patient alone with the others you have yet to transfer. Bedside healthcare is changing. It’s frustrating for all nurses, but when your experienced ICU nurses are scared, you should listen. People are going to die due to short staffing and to moving patients through the system at an unsafe, fast pace. All due to reimbursement issues.
Thank you Briann!
brieann.rn@gmail.com says
Thank you so much for sharing! Excellent points, sadly.
Joe Alves says
I’m not a nurse. My granddaughter was born at 26 weeks and spent a great deal of time in NICU. It was a scary time. The NICU nurses were formidable, and my granddaughter survived thanks to them. I will never be able to thank them enough. They were absolutely incredible. From bringing her back to life often times and within seconds, to carrying her in their arms for “bonding”, they did it all. Thank you so much for all you do. You’re the heart and soul of healthcare.
brieann.rn@gmail.com says
Thank you.
Herminia B. Tirado RN says
Well said, you described that reality of being an I C U nurse, I had work in icu, ccu, then got bored went back to surgical icu trauma unit, after my Hosp closed ( after being there for 29 yrs). Got accepted in neuro icu retired when I was offer electively. My back was saying to take the retirement. I work in icu for total of 43 years. I loved all those yes. I’ll never regret it.
brieann.rn@gmail.com says
Thank you, and thanks for sharing.
beachman says
Only two patients. I love when I hear that because it shows me ignorance still exists. The story was objective,truthful and well written.
beachman says
been a ICU nurse for 16 years, still love it and pretty much have gotten use to waiting to get home to eat and toilet.not all days this happens but it does happen.
feodora jacobsen says
Every nursing specialty has it’s thing, ICU/CCU is fab. My experience regarding workplace violence(WPV) in ICU is that it tends to be from families more than the patients. Comments? Studies show WPV is in the ED and Psych Departments but ICU’s also experience it.
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Meg Ramstad MSN ARNP says
Beautifully written. I am a proud critical care nurse now ARNP… And I loved every minute of it for every reason you gave.