When I first started on intensive care I loved it. We worked with another experienced nurse for the first few months so you could understand how everything worked. And then we had a little observation shift and if we passed we got to go into the numbers and work by ourselves. At this bit I started to have a (very large) wobble. I freaked out, dreaded going into every shift, scared as to what was going to happen, was I going to be in a cubicle, was something going to happen that I didn't know how to deal with? I found shifts at work really horrible and difficult for quite a few months, and I built up a few mechanisms to get through them. I want to share these with anybody who may also be going through the horrible parts of a new nursing job.
1. Go hour-by-hour. Going into a 13 hour shift was daunting to me, and I'd want to leave and go home. I started telling myself to get to the hour, and then the next, and so on, and eventually you get to over half way through. By which point, you've gotten that far, you can do the rest. I use my shift planner to tick off the hours as they go with the tasks needing to be done.
2. Be visual. Write down everything that you need to get done on your shift! I still live religiously by this, it kind of takes away any rushed thoughts. I use an hour by hour shift planner, and write on it, every drug, any infusion needing preparing, my safety checks, assessment, tissue viability scoring, to do my charting (every hour!). It makes my head feel more organised and prepared if everything is written down. And then tick it off as you've done it, that's the best feeling.
3. Remember how far you've come. I would walk into the unit and tell myself, I've made it through 4 months of shifts here and I've survived. Nobody has come to any harm from me, and I've always pretty much completed all my tasks. It helped a lot, and I still give myself this little pep talk when I have a difficult patient.
4. Time doesn't stop. However bad your shift may be, it will end, you will go home, and you will handover to someone else.
5. Talk to someone. I found it really difficult to talk to people, we are a large unit and I kind of felt a bit insignificant. But when I had a panic with a patient on a night shift, I spoke to the nurse who was supporting me, and she said everybody goes through the same thing and gets through the other side. At the time, I just thought she was just trying to make me feel better but literally nearly every PIC nurse I've spoken to, hated it when they started in the numbers, everybody found it scary and probably everybody looked to leave. And when I started to confide in people that I was really nervous at work, they would tell the team leaders who would check on me more regularly during shifts to make sure I was okay. And I really appreciated that.
6. Plan your days off. I found that on the days when I didn't get out of bed until midday, I felt so much worse about my whole life. I'd wasted the time I actually got away from work and just felt crappy. I started the get-out-of-bed-within-30-mins goal, and I've felt so much better because of it. I still get time to play on my phone in bed, but actually have the day to do productive things.
7. Look at other places. If you really think the place you are is no where you're meant to be, that's okay! I started to look around at other wards, and I set up shadows days so I could see what it was like in other places. It's never the end of the world if you want to change wards.
8. Food. How you fuel your body will affect how you feel. Something I'm still trying to teach myself to this day. I like to eat junk food, and especially on shift when I'm late having breaks and only have a short period to eat, I tend to gran unhealthy things. But I know this won't positively affect my brain. So I tell myself, if I eat my healthy food first, I can eat my junk. It might not be how the dieticians advise it, but I look forward to that chocolate bar.
9. Find your inspirations. Mine is looking at inspirational quotes on pinterest, finding craft ideas I may one day do and watching youtube videos on planners. It lets me switch off and remember the world outside. And why I started my journey as a nurse.
10. Remember the patients. When I found it scary to be with this poorly poorly child for a shift, I would spend just a few minutes sitting next to them. I hold their hands, look at their faces and remind myself, this is a child, somebody loves them with all their might and if they knew what was going on, they'd be so scared. I'm there to be their advocate, their person and I treat them how I'd want my child to be treated. They're not scary, they're a scared baby fighting for their life.
I really hope if you're going through a tough time at work, wherever you may be, you can find some tools that help you. Tough times will end, and there will be a light at the end.
Year 2 placements! I loved this year, I started to feel more confident and excited to qualify. And earn money! Again, I had 3 placements, 2 that I loved loved, and 1 that I didn't enjoy as much. Here's the stories..
Placement 4: I started 2nd year off with a health visiting placement, and this was the place I didn't enjoy. My mentors were lovely, and taught me everything they could. But I just didn't care that much. In hindsight, I should've taken more from that experience but I had a feeling that intensive care was where I wanted to be and going round to people's houses and talk about their newborn baby wasn't something that interested me. We would do newborn checks, clinics for development stages and teenage parents sessions. I couldn't wait for it to finish and get back into the hospital.
Placement 5: This was a little bit of heaven in a hectic hospital. Surgical Day Care. It was such a lovely unit, the staff, the patients and families and how the unit was run. My mentors were so supportive and always happy (probably because they worked on the best ward). We would admit patients in the morning, with things like, a finger trapped in the car door or fallen over and cut their lip or a tongue tie. We would walk them to theatre, their mums and dads would always cry on our shoulders and half an hour later they'd be reunited in recovery. Back to our unit for 4 hours post-op, have a wee and drink something and off they go home. So it was a bust rush in the morning and lunch time, but by the afternoon, families start going home, and things quieten down and by the end of the day, all clean and empty beds! It was like bliss. But within this bliss, I knew I wouldn't want to work there because there wasn't any nursing substance. It was all admission and obs! Nothing to learn and stick your teeth in to.
Placement 6: My dream came true in my final placement of PIC. I prayed to get intensive care as my placement, and I got it for my final and longest one. I was ecstatic. And my mentors were beyond amazing. I remember being on the bus home after my first week, on the phone to my mum saying I wanted to be that clever when I'm qualified, I just loved everything about it. It was a smaller unit and team than where I work, but everyone was knowledgable and loved to teach. We had long term patients I got to know and become friends with, and short term surgical and acute patients. It just reiterated my love for intensive care. The knowledge people have there is just beyond anything I can imagine sticking in my head.
Blood gases are tests that are carried out very frequently in any ICU. We take a small bit of blood from either an arterial or venous line (or you can use capillary by pricking their toes with a lancet if they give you enough blood - little babies never do!), and run it through a machine on the unit. We, as nurses, complete these throughout our shift, sometimes every hour or once a shift depending on the stability of the patient. We do a gas every time the ventilator settings have been changed or after extubation so we can see how they’re coping with the new changes. On our cardiac patient we do ‘paired gases’ which means we do one each from the artery and vein and compare the two. We are looking at the saturation’s in each which shows how well the heart-lung-body circuit is working. The rule of thumb is that we don’t want the difference between the two saturation numbers (also called, the extraction) to be greater than 30. Otherwise this shows low cardiac function.
Gases just give us a good overall picture of how our patient is doing, and they’re quick and easy to do ✨
As a student going to an ICU placement, or as a new starter to ICU, I wouldn’t worry too much about learning all of the different things a gas tells us. Just start with H+ (some hospital call it pH, others H+ which just means hydrogen ions), as this tells us the overall status, if it’s within range, we don’t worry as much because they are coping well with whatever is being thrown at them, their body is still working to a ‘normal’ inside. If the numbers are outside the range, their body can’t cope with what is happening and we need to do something to help. The second, and last, number I would focus with, is the lactate. This is how hard the body is working to deal with everything. Less than 2 is ideal, less than 3 if they’re cardiacs. Anything above 3 and we’re concerned. The highest I’ve seen is 16 and unfortunately they passed away a few hours later.
Below are the flashcards I have on blood gases and they go into a bit further detail about respiratory and metabolic conditions...
One of the go to tips for student nurses and nurses alike is to keep a notebook for all the important information you might need for the unit you're on. And I lived by this notebook all through nursing school and into the first few months of working on intensive care. When my workplace changed the protocols of something I had written out, I was kinda bummed. I didn't want wrong information in my notebook but I couldn't just rip it out or cover it. So I had to start all again, and eventually I decided on making flashcards on a keyring to make them interchangeable. I've had a few requests asking how I make them or if I buy them somewhere. This post is going to go through how I make them; all are homemade in my living room with cheap supplies! Here's how to do it..
Items you need,
- White card
- Colourful pens
- Black pen
- Cute tape
- Books/internet for information
- Laminator (optional)
- Hole punch
All of these are pretty much from Wilkinsons, Sainsburys or Amazon.
I draw out 5 flashcards on the white bit of card, mine are 12cm x 8cm, it's just what works for me and my pouch that I take to my desk, and it can fit a good amount of information on. Next, cut them out :)
I next put all the washi tape onto the flashcards so I know where I'm writing from. I use this pink tape from paperchase but there's loads on Amazon and eBay, all pretty cheap. This one has really fine little patterns on and I count 10 them so each one is the same size. I do this on the front and back.
Next is to add your information. Here I did all the things I need to remember when setting up a bed space for a new admission to PIC; and what the protocol is for IV anti-biotics post cardiac surgery. I get my information from my workplace intranet, protocols, pinterest and books. I like to add colour with pinks, oranges, greens and blues, to make it fun and easy to look through and find what I need. I use a permanent pen to do my titles as normal pens won't write on the washi tape. Then, hole punch the corners to add onto my loop. I normally use a single hole punch which is easy but my other half decided to play around with it and broke it! So I'm using a big one which is kinda tricky.
I like to laminate mine, just because it gets thrown round a bit in my bag and on my desk, and sometimes it gets left on and medicines can get spilt. For some reason we had a laminator in our house from somewhere so I didn't have to pay extra for one, but you can get one on Amazon for about £15. And lastly, just have to cut them out and punch the hole through the laminate and hook it to the rest of them. If they start to peel after a bit of use, just run them through the laminator again and it should help to seal any loose bits.
And that's it really. Nothing fancy or anything. It's never the neatest and sometimes I make mistakes but it's only really for my knowledge so it's okay :)
If you have anything similar, I'd love to see!