What's it like to work in the ICU?

Alright peeps, let me first preface this by saying I have only worked as a registered nurse in my ICU for a grand total of three months. So please make no assumptions that I know all there is to know about working in an ICU. I have still so many things I have yet to experience and learn. I'm just so excited about everything and really wanted to document this for my own purposes (to look back on 5 years from now and laugh at how much I didn't know) and also for anyone who may be even mildly interested in knowing what goes on in an ICU in the hospital.

Also, another caveat, most of these photos are going to be stock photos I found online because taking pictures of patients in the hospital is generally frowned upon. So bear in mind that the photos are representative of a general idea of what an ICU looks like and is not my ICU specifically.

Finally, without further ado, let us begin.

What is an Intensive Care Unit anyway?

•  To put it simply, the ICU is the place in the hospital where the sickest, most critically ill patients go. There they can be taken care of by doctors who specialize in intensive care (they're called Intensivists... go figure).

 What does an ICU nurse do?

• Well all the main nurse type stuff you'd normally think of, like administering meds, performing assessments, etc etc. However ICU nurses are also trained on how to perform more advanced skills like caring for arterial lines, obtaining central venous pressures, titrating a myriad of high risk medications, among many other things (but perhaps more on that later). However in my opinion what really sets an ICU nurse apart is their ability to intensely and diligently monitor their patients and be able to interpret and act upon any changes that may occur.

An example of what an ICU monitor may look like. Each colored line is a waveform that represents a different type of measurement such as heart rate, blood pressure,oxygen level, etc.

The patients are usually complicated.

• I saw this meme not too long ago that said something to the effect of the ICU is the place where there's a tube for every hole and if there's not a hole we make one... and put a tube in it. Which is pretty accurate actually. When you walk into a room in the ICU it can be very overwhelming to see someone hooked up to so many different things, especially when you don't understand what they are. I try to explain what each thing is to patient's family members because it is very traumatizing to see a patient with a tube down their throat and one coming out of their chest, and another coming out of their nose... it's a lot to take in.
• Additionally, patient's in the ICU generally don't have just one thing wrong with them, it's typically a whole slew of issues. Multiple organs are failing in the setting of a person with multiple diseases, or someone with multiple traumatic injuries. One intervention that you do to help one issue the patient is having may exacerbate another problem. It's a fine balance of risks and benefits and overall what is the option that is going to lead to the best outcome for the patient? 

 

Death is common.  

• Critical care medicine has definitely come a long way since it began in the 1960's. More people now survive their life threatening illnesses thanks to advancements in critical care than would have 50 years ago, or even 15 years ago! However the mortality rate in most ICU's is still 10%-29% (that statistic comes from the Society of Critical Care Medicine), leading the ICU RN to witness and be around death quite regularly.
• With this amazing advancement in medical technology and our ability to keep people alive comes some serious ethical issues. Some things can be and are worse than death, and the possibility of only surviving on long term life support with low quality of life are all issues that are very real. Family members and the medical team are sometimes faced with difficult decisions on whether to continue intervention or to allow the person to pass naturally. Ethical issues such as these can be common place in the ICU, and there's usually not an exact right or wrong answer (I could continue talking about ethics in the ICU but for the sake of time I will refrain... anyone who is interested in further discussion can message me). 

We get to play with some pretty cool technology. 

• Most everyone have heard the phrase 'life support', but if you're not around it all the time you probably don't really know what that means. I know prior to my nursing education I didn't. Life support is anything that helps support essential life functions. That could mean having a tube placed in your airway and connected to a ventilator to help you breathe, or IV medications that raise your blood pressure, or a machine that filters your blood like a kidney would and then returns it back to you. There is so many different things we can utilize in the ICU to support organ functioning and keep people alive, and depending on which ICU you work in and what types of patients it specializes in you may work more with one thing than another.

The ICU IS AWESOME.

• I suspect I've already lost a lot of people's attention cuz this is getting a wee bit long, and I could seriously go on forever because I just love critical care so much, but we will end it here. Suffice it to say that the ICU is really an incredible place that honestly does save lives and I feel so honored to have the privilege to work where I do and with such amazing people who I look up to and have the opportunity to be mentored by.