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whitewriterInstead of doing mandatory training I decided to write some lists and reviews instead.
I figured fair's fair. I did midwifery the other day so now is ICU's turn.
Things I like about ICU
1. Care needs are counted against nursing hours required for patient needs, and staff are allocated accordingly. This makes it very easy to predict workload and staffing needs - compared to midwifery - especially in districts where women have high risk.
For example. In midwifery you have a set number of midwives on daily. Say the number is 8 for morning shift, 9 for pm and 9 for night. If you have 5 IOLs, then you still get the same number of staff. If you have 6 IOLS and say, 3 spontaneously labourers walk in ... you still get the same number of midwives.
While in ICU, if you have 5 pt and only need say 3 RNs, but you have 5 permanent staffers rock up to shift, you get 4 (1 in charge and 3 RNs as needed) and then 1 person will be sent to the other unit which is short or busier. Being sent isn't fun but you take turns and it keeps your skills fresh because you then get to have a day in cardiac or general-- so the perk of in charge is you get sent a little less. Seniors also get sent less.
2. You don't have to do a lot of talking.
the patient is either ventilated or confused. Beyond the questions required to ensure for a good GCS, or to reassure the patient that they're safe and they need to stay in bed... there's not much to explain. That they're connected to lines and what the lines do - the patient doesn't see the numbers on the screen behind the bed and they don't question us on them (whilst in midwifery the woman is basically staring at the CTG).
3. It's rare that a patient or their family will ask where I live, or where my parents are (because you can't figure out what nationality I am from looks) or if I'm married or have children. Rare. Possibly once a month this comes up, if not less frequently. I usually don't mind and use it as a topical discussion to learn more about their culture and identity. If they look European I'll spruke that my dad is Maltese and if they're Asian I'll explain that my mum is Indonesian-Chinese. I'll do anything to get on someone's good side.
4. Your break times are set.
Barring a deterioration or drama going on in the unit, morning tea, lunch and dinner are almost at set times. There's little argy bargy except from the odd weirdo nurse (just the one) who plays the "I don't take breaks" card who then almost always rescind that at about 18:00 on a day shift and at 03:00 on a night shift making the person she's swapping with life very hard (unless they're smart and they go first). There is a really good culture of covering someone for their breaks. Your allocated your break buddy or break team for the shift, and as a team or buddy set, you sort out who goes when and you work together. In midwifery it's like - sort yourself out. If you wanna go for a break you need to declare that for yourself, find your own buddy swap.
5. Things are more clear cut. We are protocol driven. There's a protocol for almost everything. You can plan your day in the morning, and get into a rhythm and just get your shit done. If the planned scan time gets lagged that's probably the worst thing that can happen that day (short of a deterioration -- but everything is so closely monitored, those still seem rather predictable).
Things I dislike about ICU:
1. 50% nightshift
We could do 8s. But most of us do 12's. 12's pay more on the weekend (simply because your working more weekend hours) and since you're there you might as well just stay a few extra hours.
2. When your patient shits the bed 6 times in a shift, and they're ventilated, and they're big and you feel terrible because you really just need to let them "lay in the poop" just for a bit to ensure they actually finish going, before you roll them. Because it'll take 3 people and you've already done it 6 times that day, and clearly, how is there still more to come out?!
3. Aspirating the NG 4th hourly.
That stuff smells. It makes me gag.
4. When the surgeons do a radical surgery (that they obviously had consent for) but you can clearly see that they bend the rules doing that surgery.
We had a 14 year old boy once in our adult ICU (I hadn't ever nursed a teenager before outside of mental health) and the letter the surgeon's registrar wrote to the Adelaide Health govt to allow the child to come through onto the NSW Health service, included a line "basically the size of an adult" LOL. Seriously couldn't be further from the truth. He looked like a normal, very thin, gangly 14 year old boy. I was shitting bricks that day, should his observations be considered different? How much did he weigh? I don't want to fluid overload him by accident...
Or here's a dodgy one. There was a 46? year old gentleman with learning difficulties, obesity, utilises a 4ww, who had moya moya and a massive AVM. And he was in decline (physically and mentally also) due to these brain conditions - and the surgeon said he could fix it 80% chance of being worse though, and 20% of being better. The man was very afraid of the surgery. He knew he had to have it (or face being more disabled at a slower rate) or to just take his chance at 20% improvement but 80% chance of being a vegetable. His family wanted him to have the surgery. The educator, had to go and buy him a pack of cigarettes which he smoked out the front of the hospital prior to signing the consent form. And he lay in ICU as a vegetable postoperatively for at least a month, with a huge, swollen tongue, sticking out of his mouth. So swollen we couldn't stick it back in. We put vaseline on it to keep it moist. It looked painful, so we put lignocaine on it to numb it. It looked horrible. He got sores because he had an ETT as well down there.
I'm fairly sure he ended up with a tracheostomy just so they could ship him upstairs, not any more alert than your cabbage or carrot. Who knows what was going on in his head for all those months in ICU. I can't remember his name, but if I said to any of the old seniors "remember the guy with the tongue?" They'd know who I meant.
Where is he today, I wonder.
These cases, however are rare. They're about 2 a year. Sometimes we wonder if the surgeon just wants to do them because they need to practice and learn, and complicated (also risky) cases are the best way to do that ...
5. Oh. Okay here's one that isn't related to the ICU itself nor the job itself. But the title of ICU nurse. I didn't realise, how elitist it can be to say you work in ICU.
Immediately upon saying it, people think your the shit. They seem to think your really clever, or are in some way better than ward nurses. That you know how to deal with emergencies better than anyone else (we're supposed to be, but that's definitely not always true). That because you can "handle ICU" you can "handle anything". Whilst I'll agree it does take a certain personality type of thrive in a place that is both so regimented and strict, but also has quite a fair amount of nursing autonomy- we all get trained for this, and we're great in emergencies when we are in our element (that is, inside the ICU) but take away our machines, take away our well stocked trolley, and arterial lines and central lines: and we're like a fish out of water. I can't cannulate (yet) I can barely take blood from anyone who isn't ridiculously easy with veins popping in my face. I've never done CPR. I've been ALS trained -- God knows how many times, but I've never had to use those skills in real life.
So when I came into midwifery, I may have significantly misjudged how much this "prejudgement" of my skills, will affect me - in so much that I then put increasing pressure on myself, to actually be 'better' faster than might be natural for my own skills.
I hated having the ICU cloud around my neck at the start of midwifery, and it still feels like it has followed me to SSH (although its receding fast since I don't get asked daily "Where I come from" anymore). Honestly - it translates in some ways (ask me to do an ECG or GCS ) But doesn't translate to talking about risk factors or what's normal movements for baby in a reassuring manner, or feeling confident giving advice when women are experiencing pains and cramps and all sorts of gestations.
Today when I walked in the door at work, one of the night shift girls was like "you haven't even started and you already look like your hating life".
Then I had one of the women ask me why I was so tired looking, and I inquired why she thought that, she pointed to these dark circles she could see below my eyes (that I never noticed -- I don't wear make up) but I also don't really look at my face much. Like, if it hasn't got acne on it I consider that FANTASTIC ... there's no acne at the moment..
Am I reading too much into their words? Can I make it to December?
The boss came to me wanting me to book leave for March. I signed for 4 weeks in March. I don't see myself there in March (I hope I'm not there in March) so I basically didn't even really look at the dates I signed up for (but I think my friend I'm bridesmaid for might be getting married then so, March is a fine choice).
I found this webpage today (you'd think I'd be living under a rock). I always knew about the spooky awards for fanfic but I never really looked into how to find the lists of where to find who won what for which category: but now I know: https://fanlore.org/wiki/Spooky_Awards/Spooky_Awards_2001
More fic to read/reread. A lot on the list of Spooky Awards again looks familiar.
I figured fair's fair. I did midwifery the other day so now is ICU's turn.
Things I like about ICU
1. Care needs are counted against nursing hours required for patient needs, and staff are allocated accordingly. This makes it very easy to predict workload and staffing needs - compared to midwifery - especially in districts where women have high risk.
For example. In midwifery you have a set number of midwives on daily. Say the number is 8 for morning shift, 9 for pm and 9 for night. If you have 5 IOLs, then you still get the same number of staff. If you have 6 IOLS and say, 3 spontaneously labourers walk in ... you still get the same number of midwives.
While in ICU, if you have 5 pt and only need say 3 RNs, but you have 5 permanent staffers rock up to shift, you get 4 (1 in charge and 3 RNs as needed) and then 1 person will be sent to the other unit which is short or busier. Being sent isn't fun but you take turns and it keeps your skills fresh because you then get to have a day in cardiac or general-- so the perk of in charge is you get sent a little less. Seniors also get sent less.
2. You don't have to do a lot of talking.
the patient is either ventilated or confused. Beyond the questions required to ensure for a good GCS, or to reassure the patient that they're safe and they need to stay in bed... there's not much to explain. That they're connected to lines and what the lines do - the patient doesn't see the numbers on the screen behind the bed and they don't question us on them (whilst in midwifery the woman is basically staring at the CTG).
3. It's rare that a patient or their family will ask where I live, or where my parents are (because you can't figure out what nationality I am from looks) or if I'm married or have children. Rare. Possibly once a month this comes up, if not less frequently. I usually don't mind and use it as a topical discussion to learn more about their culture and identity. If they look European I'll spruke that my dad is Maltese and if they're Asian I'll explain that my mum is Indonesian-Chinese. I'll do anything to get on someone's good side.
4. Your break times are set.
Barring a deterioration or drama going on in the unit, morning tea, lunch and dinner are almost at set times. There's little argy bargy except from the odd weirdo nurse (just the one) who plays the "I don't take breaks" card who then almost always rescind that at about 18:00 on a day shift and at 03:00 on a night shift making the person she's swapping with life very hard (unless they're smart and they go first). There is a really good culture of covering someone for their breaks. Your allocated your break buddy or break team for the shift, and as a team or buddy set, you sort out who goes when and you work together. In midwifery it's like - sort yourself out. If you wanna go for a break you need to declare that for yourself, find your own buddy swap.
5. Things are more clear cut. We are protocol driven. There's a protocol for almost everything. You can plan your day in the morning, and get into a rhythm and just get your shit done. If the planned scan time gets lagged that's probably the worst thing that can happen that day (short of a deterioration -- but everything is so closely monitored, those still seem rather predictable).
Things I dislike about ICU:
1. 50% nightshift
We could do 8s. But most of us do 12's. 12's pay more on the weekend (simply because your working more weekend hours) and since you're there you might as well just stay a few extra hours.
2. When your patient shits the bed 6 times in a shift, and they're ventilated, and they're big and you feel terrible because you really just need to let them "lay in the poop" just for a bit to ensure they actually finish going, before you roll them. Because it'll take 3 people and you've already done it 6 times that day, and clearly, how is there still more to come out?!
3. Aspirating the NG 4th hourly.
That stuff smells. It makes me gag.
4. When the surgeons do a radical surgery (that they obviously had consent for) but you can clearly see that they bend the rules doing that surgery.
We had a 14 year old boy once in our adult ICU (I hadn't ever nursed a teenager before outside of mental health) and the letter the surgeon's registrar wrote to the Adelaide Health govt to allow the child to come through onto the NSW Health service, included a line "basically the size of an adult" LOL. Seriously couldn't be further from the truth. He looked like a normal, very thin, gangly 14 year old boy. I was shitting bricks that day, should his observations be considered different? How much did he weigh? I don't want to fluid overload him by accident...
Or here's a dodgy one. There was a 46? year old gentleman with learning difficulties, obesity, utilises a 4ww, who had moya moya and a massive AVM. And he was in decline (physically and mentally also) due to these brain conditions - and the surgeon said he could fix it 80% chance of being worse though, and 20% of being better. The man was very afraid of the surgery. He knew he had to have it (or face being more disabled at a slower rate) or to just take his chance at 20% improvement but 80% chance of being a vegetable. His family wanted him to have the surgery. The educator, had to go and buy him a pack of cigarettes which he smoked out the front of the hospital prior to signing the consent form. And he lay in ICU as a vegetable postoperatively for at least a month, with a huge, swollen tongue, sticking out of his mouth. So swollen we couldn't stick it back in. We put vaseline on it to keep it moist. It looked painful, so we put lignocaine on it to numb it. It looked horrible. He got sores because he had an ETT as well down there.
I'm fairly sure he ended up with a tracheostomy just so they could ship him upstairs, not any more alert than your cabbage or carrot. Who knows what was going on in his head for all those months in ICU. I can't remember his name, but if I said to any of the old seniors "remember the guy with the tongue?" They'd know who I meant.
Where is he today, I wonder.
These cases, however are rare. They're about 2 a year. Sometimes we wonder if the surgeon just wants to do them because they need to practice and learn, and complicated (also risky) cases are the best way to do that ...
5. Oh. Okay here's one that isn't related to the ICU itself nor the job itself. But the title of ICU nurse. I didn't realise, how elitist it can be to say you work in ICU.
Immediately upon saying it, people think your the shit. They seem to think your really clever, or are in some way better than ward nurses. That you know how to deal with emergencies better than anyone else (we're supposed to be, but that's definitely not always true). That because you can "handle ICU" you can "handle anything". Whilst I'll agree it does take a certain personality type of thrive in a place that is both so regimented and strict, but also has quite a fair amount of nursing autonomy- we all get trained for this, and we're great in emergencies when we are in our element (that is, inside the ICU) but take away our machines, take away our well stocked trolley, and arterial lines and central lines: and we're like a fish out of water. I can't cannulate (yet) I can barely take blood from anyone who isn't ridiculously easy with veins popping in my face. I've never done CPR. I've been ALS trained -- God knows how many times, but I've never had to use those skills in real life.
So when I came into midwifery, I may have significantly misjudged how much this "prejudgement" of my skills, will affect me - in so much that I then put increasing pressure on myself, to actually be 'better' faster than might be natural for my own skills.
I hated having the ICU cloud around my neck at the start of midwifery, and it still feels like it has followed me to SSH (although its receding fast since I don't get asked daily "Where I come from" anymore). Honestly - it translates in some ways (ask me to do an ECG or GCS ) But doesn't translate to talking about risk factors or what's normal movements for baby in a reassuring manner, or feeling confident giving advice when women are experiencing pains and cramps and all sorts of gestations.
Today when I walked in the door at work, one of the night shift girls was like "you haven't even started and you already look like your hating life".
Then I had one of the women ask me why I was so tired looking, and I inquired why she thought that, she pointed to these dark circles she could see below my eyes (that I never noticed -- I don't wear make up) but I also don't really look at my face much. Like, if it hasn't got acne on it I consider that FANTASTIC ... there's no acne at the moment..
Am I reading too much into their words? Can I make it to December?
The boss came to me wanting me to book leave for March. I signed for 4 weeks in March. I don't see myself there in March (I hope I'm not there in March) so I basically didn't even really look at the dates I signed up for (but I think my friend I'm bridesmaid for might be getting married then so, March is a fine choice).
I found this webpage today (you'd think I'd be living under a rock). I always knew about the spooky awards for fanfic but I never really looked into how to find the lists of where to find who won what for which category: but now I know: https://fanlore.org/wiki/Spooky_Awards/Spooky_Awards_2001
More fic to read/reread. A lot on the list of Spooky Awards again looks familiar.
