What really is Critical Care?

[Old_School]

HA . . .gotcha!

To all you lurkers, come out from behind the curtain and tell me what you think. Then I'll share with you what I've discovered of the last thity years.

O_S

[nursinghumor]

If I can, I'll ask your opinion.

I started my nursing career in Med/Surg/Tele seven years ago. Worked for two years in a hospital then went agency. Did home health, LTC then became a stay at home father for the past three years and got involved with a website venture as a nurse entrepreneur.

I've worked mainly in LTC, let my hospital skills go unfortunately.

My question, I want to end up in Critical Care. Would you recommend that I look for a job in the ICU/CCU, or go back to med/surg/tele to build my skills/speed/organization back up?

Andrew Lopez, RN
http://www.nursinga2z.com

[Old_School]

I think that you should just go for it. You already have assessment skills and time management pretty well mastered after seven years. One of my pet peeves is hiring freshly minted RN's to the units. They have no idea what a sick person looks like and time just slips away from them when things get ugly. Find a hospital that will give you 6 weeks training to get you up to speed. I'm not saying it will be easy, if it was everyone would be doing it. It also would be wise to do a little study on your own.

O_S

[nursinghumor]

Appreciate the feedback. My wife who's an RN in the ICU keeps asking me why I'd want to go back to Med/Surg.

Guess I feel like I wasn't there long enough in the first place to really get comfortable with my skills.

I'm lucky to have a built-in preceptor, experienced ear to ask questions in my wife.

Walked in on a patient going into CHF in a subacute rehab over the weekend. Wasn't immediately sure what was going on, but after seeing his color, lungs full of crackles and 2-3+ pitting edema I got the idea something wasn't right.

Luckily an older nurse that knew the patient asked me if I wanted her to take a look. She took one glance and said we needed to send him out 911. She didn't freak out on me, didn't instantly assume care of the patient. She told me what we needed to do and made sure it got done.

There are definitely days when you have to appreciate other nurses who know more than you do and are willing to share that knowledge.

Andrew Lopez, RN
http://www.nursinga2z.com

[Old_School]

I'm glad your wife agrees with me.

O_S

[Old_School]

This question has been posted for a little over two weeks now. No one has really attempted to answer it so I'll tell you what I think it is. Remember, you had your chance.

Critical Care is a state of mind. It is whatever the nurse thinks it is. Critical care is wherever the nurse is and he/she alone makes critical care happen . Did you ever see a doctor make critical care happen? No, you've seen him panic and shout orders from algorythms that he has memorized. It's the nurses following those orders and doing them correctly that makes critical care happen. Did you ever see a doctor ever look at anything other than his pet organ system. No, the nurses have to determine whether or not his orders are consistent with what is going on with the other organ systems. Then they must co-ordinate with the other doctors and their pet organ systems.

No question that the nurses in critical care need to be educated. However education alone does not make the critical care nurse. I've seen LPNs that could make critical care happen better than most RNs I know. You have to have heart to do this job correctly. Also you need a deep desire to save lives and the ability to let go when its appropriate.

In critical care, people are always asking for your opinion. That is why it is of the utmost importance that the nurses have opinions. I couldn't get very many people here to give me an opinion on even coffee and donuts.

So that's what I think Critical Care really is. Do any of you think its anything different?


O_S

[Old_School]

With the new forum, it looks like I'm going to have to start bumping my posts to keep them in play. I figure I'll start with this one. I have nothing to add but I would like to hear what you think.

Cordially,
O_S

[grapejam88]

I was on vacation for a while and haven't been "lurking" much here (or anywhere). I have been immersed in critical care for about 11 years now and wouldn't change for the world. The thing I love about critical care is that I am not just merely organizing how I will give my meds to all of my 8 patients and coordinate all of their rehab and tests were I a nurse on med-surg, but rather how I am going to coordinate the cares for one/two/or three ICU patients from head to toe, intead of system-focused as it often is on a general floor. I love (and also hate) at times how I am basically in charge of deciding how they will live through my shift by using the orders given me by the doctors I help train. I love that I have q15 minute vital signs, q 15 minute phone calls from people claiming to be family wanting updates, doctors/dieticians/social workers/case managers/pharmacists/x-ray techs/ECHO techs/GI endoscopy crews all tugging on your sleeve while talking on the phone with the family member that won't stop talking while my patient's norepinephrine drip is beeping. Then suddenly I get done with all of that and I realize I am late for my q1 hour finger stick on my other patient . Ahhh...relaxing, isn't it? I love it. I don't want to relax for a minute and let my mental guard down, because for me, critical care is a constant state of stress and that stress helps me focus. It is a good stress for me most of the time. I do not do well with what I feel is (and this is a PERSONAL feeling based off of my needs in my career) mindless running about on a floor chasing down tasks and coordinating a slew of patients..half of which are out for a smoke. I need to focus. That's my take on critical care. It is my mindset.

[1mg.epi]

I worked CVICU for 5 years and left for Out Patient work. All I do is hang I.V.'s . i.e blood, antibiotics yade, yade, yadi. I HATE IT. I am going strak raving mad with the silly a.. stuff I do. No thinking. I have recently talked to my old boss who wants me back. Oh, soon I will be back in front of a IABP, vent and 3-4 vaso gtts. My brain wants to work again. I crave the "POWER".

[Dorimar]

****o, I am new to this forum and this is my first reply to a thread. It is not intended to offend, so i hope that it does not. However, you have touched on a pet peeve of mine. I think the term Critical care and Intensive care can be interchanged. What I have seen a lot lately, is that some nurses come to ICU form M/S or Tele because they think the work load is easier. Then these nurses give the same level of care to their 2 patients that they gave to their 5-8 patients. To me Intensive care means Intensive care. You have to check your patients often, you have to know not only about their currnet disease process, but all other medical hx and complications that have arisen since their stay.You need to know what the drugs they are on can do. You have to follow their progress and be up to date on their current lab work and Xray trends. You MUST know why your patient is on a titratable drip and how and why to tirtate that drip & know what your ordered parameters are. You must know the normal values & what the waveforms should look like of your Swans, CVP's, ICP's etc (in order to know if they are abnormal). If you do NOT know this about your patients, then you need to get off the internet, put your magazine down, decrease your number of smoke breaks, & take the time to find this out, & you need to spend some time in your patient's room (monitor's tell a lot but not everything). So now I'll get off my soap box. And please remeber that i did not say ALL nurses that come from the floors are like this .