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Our prime purpose of personally getting in touch with people who wear nursing scrubs is to give you a perspective on how tough their profession is. Previously, we featured here an email interview with Kim McAllister, RN - an ER nurse at the same time a popular blogger. And today, we decided to explore the life of a critical care nurse and a palliative care nurse.
Besides working in Emergency Room, taking care of critically ill and terminally ill patients are indeed a challenge. And to prove that critical care nursing and palliative care nursing are really among the most exciting and challenging careers in the nursing sphere, we again did an email interview to a successful critical care nurse and a palliative care nurse.
Our first interviewee who gave some insights about critical care nursing has been a registered nurse for 18 years. He has spent working in Emergency Room and Critical Care Units. He is also one of the active expert nurses that can be contacted online in case you have questions regarding nursing as a career; a man in nursing scrubs; or a nurse in emergency room and critical care units. The person we are referring to was the 2009 Star of Life Recipient of the American Ambulance Association
I have been a nurse since 1993 and if it wasn't for my wife being a RN first, I wonder if I would have taken this route. Men in nursing were not a very popular career choice in those days. Even now, men comprise only about 5.8% of the nursing population. http://www.minoritynurse.com/minority-nursing-statistics
Ken: My wife became a Registered Nurse right out of high school and was established about 4 years before I gave some serious thought about becoming a nurse myself. I could see that she enjoyed helping people in need and had a very secure future. I had a degree in Business Management and was a Retail Manager for the Army and Airforce Exchange Service (AAFES) and then subsequently a Real Estate agent for Century 21 after learning that retail was not what I wanted to do with my life.
I was 29 years old in 1989 when I noticed that the economy was slowing for real estate. I knew that I had to make a career change to keep up with the changing economy and support my growing family. I was a volunteer Emergency Medical Technician (EMT) for the local rescue squad in my early 20's and really had an interest in the medical field. So, I thought that I would go to school while I did real estate to become a registered nurse. It took me 4 years part time to do a 2 year RN degree but it finally paid off in 1993 when I graduated. Since then it has been all good and I have never regretted my decision to become a nurse. I did a year in Med Surg nursing and then went into the Critical Care Unit. I became a Certified Critical Care Nurse (CCRN) in 1997 and retained certification to this date.
http://www.aacn.org/wd/certifications/content/ccrnlanding.pcms?menu=certification
I subsequently moved into the Emergency Room and used my critical care experience to thrive in the emergency area of practice. Over the years I have worked both units simultaneously until 2007 when I took a full time position as a Critical Care Transport Nurse in the Specialty Care Transport Unit (SCTU). This is basically taking the emergency room and the critical care unit and putting it on wheels to transport the critically ill patients from one hospital to another by ambulance. For example, if you had a major trauma patient that was brought to a community hospital, it is my job to take that critical trauma patient to a major Trauma Center for definitive care. The heart attack patient that needs emergent angioplasty at a cardiac cath center would be another type of job that I would be called to do.
More recently I have taken an additional 200 hours of on the road training with Paramedics to become a Mobile Intensive Care Nurse (MICN) of which I will be receiving my credentials from the state any day now. This designation allows me to function in a 911 capacity with a Paramedic to form a Hybrid type of Advanced Life Support Unit. A MICN and a Paramedic team up to do 911 or Critical Care Transports as needed at the time. I have the utmost respect for Paramedics as I have seen firsthand what great skills Paramedics have and use to save patients lives day in and day out. I am honored to ride with them as a specialized Hybrid and I continue to learn new tactics from each medic I work with.
Ken: The biggest challenge in Critical Care Nursing is being one step ahead anticipating the patients' needs. If you can anticipate what can happen to your critical patient, you can intervene to avert disaster and even death. You need critical thinking skills and you need to hone them so that they become part of you on a daily basis. If you wait until the patient is in distress, then it is too late. Anticipation and Intervention are the two most important aspects to critical care nursing in my opinion. Not to mention that you need to keep up with critical skills such as Advanced Cardiac Life Support (ACLS) so you can provide life saving skills when needed.
Ken: The most exciting part of becoming a critical care nurse is knowing that you are the critical patients last line of defense. You are among the most educated and experienced nurses in the hospital and are looked upon as a resource person by other nurses. I have been a night shift nurse for the majority of my 18 years and on those nights it is just you and your critical patient. The patient and their family is relying on you, the Critical Care Nurse, to make sure that they are safe and receiving the best care possible. The doctors are at home sleeping and if its 2 am and you have a critical issue with a patient, it is up to you to make the call to the doctor and paint your picture of the situation at hand. It is the critical care nurse that can persuade the doctor for orders that they feel they need to keep their patient stable and safe. How you paint the picture of your patient to the doctor can mean life or death at times. Confidence in your assessment skills and your communication with the doctor is of the utmost importance to your patient. It is an exciting area of practice that demands continuing education so that you can anticipate and intervene for your patient to achieve successful outcomes.
Ken: There were many unforgettable experiences in the critical care department but one that stands out was on a job that I had as a Critical Care Transport Nurse back in 2009. In fact, I was nominated and received the “Star of Life” award from the American Ambulance Association back in May of 2009. The awards were given out in Washington DC at the annual convention where Bruce Jenner, decathlon champion was the presenter of the awards. There were many of us from around the country that had done EMS jobs that were above and beyond the call of duty.
I was called out one night to take a critical patient from a small satellite hospital to a larger critical care unit 40 miles away. The patient was on a breathing machine(ventilator) and in the midst of having a heart attack with a rapid heart rate of 160 and a blood pressure in the 80's systolic. I was able to advocate for my patient and request certain medication and treatment orders from the receiving hospitals cardiologist that stabilized the ventilated patient during the transport to the major hospital. His heart rate had come down to almost normal and his blood pressure was raised by medications that I had requested to hang and titrate for this patient. The patient was subsequently weaned off the ventilator and further stabilized at the receiving hospital. He was discharged from the hospital about 3 weeks later on his own power. Hospital Administration had learned of the ordeal and nominated me for the award. The fact that I was able to advocate, anticipate and intervene for a successful initial outcome is a very rewarding and satisfying aspect of Critical Care Nursing.
Ken: Well, even the simplest of technologies frees up the critical care nurse to handle other aspects of care. For example, high tech monitoring devices allow for monitoring heart rhythms, automatic blood pressures, pulse oximetry, respiratory rates and end tital CO2. Each of these vital signs are represented by numbers that critical care nurses determine how stable their patients are at any moment in time. Just a glance at the monitor is a snap shot of how your patient is doing. In fact, had the famous Michael Jackson had some of this technology at home during his propofol/diprivan infusions, he would be alive today. Although that drug should never be used on any patients that are not on a ventilator, I really believe that Michael would have been better served with a Critical Care Nurse monitoring him who does this everyday rather than a physician. We have the technology to monitor end tital CO2 with an oxygen nasal cannula and a special CO2 monitor. This device when worn non invasively could monitor breathing so the drug could be titrated to effect to keep end tital CO2 between 35 and 45 mmHg. If the number rises over 45 mmHg then we know that the patient is not breathing enough to blow off the CO2. Therefore, you lighten up on the drug so he breaths more. If the number goes lower than 35 mmHg then we could increase the drug because we know that he is breathing to fast and blowing off more CO2 than necessary. That is how powerful knowledge combined with technology can maintain and save a life.
Ken: My current job in critical care transport calls for three 12 hour shifts per week. As I noted before, I do the night shift so it's from 7 pm to 7am. I enjoy the night shift as I can have dinner with my family at the normal 5 pm before getting ready for work. Not to mention the pay differential is higher and it's a much quieter setting on the night shift. Most of the non essential personnel have gone home leaving the hospital with a small family of essential personnel to work with. My job starts at 7 pm with a quick report from the day shift nurse. Then I go out to the garage and check both of the SCTU Critical Care Ambulances to make sure they are properly stocked with medical supplies, oxygen and essential Advanced Life Support equipment. Preparation is another key aspect so that anticipation and intervention can occur seamlessly in the event your patient needs life saving techniques during transport. I want to make sure that when I go for a piece of equipment or medication, that it is there and in working order for immediate use. This is something that is done daily at the beginning of each shift. Then my team which could consist of an Emergency Medical Technician (EMT) or a Paramedic if we are going to run a 911/Critical Care Transport Truck wait for dispatch to notify us of a job.
In the Critical Care Unit it is a little different in the respect that you get report for your 2 to 3 patients from the day shift nurse and then begin your assessment of each patient in your care. You then monitor and intervene as necessary throughout the night with the intention of delivering your patient back to the day shift in the same or better condition. You are responsible for all treatments and medication administrations that have been outlined in nursing care plans or doctors orders. You also must deal with family by explaining to them the plan of care and how their loved one is doing and progressing.
Ken: It normally is free for most nurses to take the critical care course. Most hospitals offer this course free to current employees. Some hospitals may even pay the nurse their normal hourly rate to take the course so that they are prepared to care for their critical patients in the Critical Care Unit. I can tell you that I was paid to take the course back in 1994. However, it may be somewhat more difficult nowadays with this recession and hospital cutbacks. I would say that it is most likely still free but you would have to take the class on your own time. The Critical Care Certified Nurse (CCRN) examination is a separate certification from a typical Critical Care course offered by a hospital. The Certification is administered as an exam by the American Association of Critical Care Nurses (AACN). It costs about $225 to take the exam. http://www.aacn.org/wd/certifications/content/initial_ccrn_certification.pcms?menu=certification Many hospitals will reimburse the nurse for successful completion and attainment of the certification.
http://www.aacn.org/WD/Certifications/Docs/Certification_PresentationPC.ppt
Ken: There are really no difficulties in accomplishing the Critical Care Course if you spend the time and effort to study by using your on-the-job experience combined with book knowledge. The only difficulty may be in trying to manage your time to attend the course while still working fulltime.
Ken: Well….in reality all you have to do is take your hospitals Critical Care Course, Basic Arrhythmias Course, CPR and ACLS and you can work as a critical care nurse after a few months of 1 on 1 orientation with your Critical Care Nurse preceptor. On the other hand it may take years of experience and book knowledge to really be a good Critical Care Nurse. It involves continuous learning and yearly competencies to maintain the status of a practicing critical care nurse.
Ken: I would say that all nurses in any field have an impact on their patients by the care and knowledge they bring to the table. However, there may be more of an impact by critical care nurses as they have the ability to change the course of their patients' life because of the fragile state of health that they can be in. Life or death may hang in the balance and an intervention by a critical care nurse could and does save lives every day in this great country of ours. Saving that life changes the family tree and the future of their children and their children's children. I don't want to get too philosophical, but you can see how one life can affect generations into the future. Critical Care Nurses save lives and preserve family trees all the time.
Ken: My advice to anyone who wants to pursue a career in critical care nursing would be to take it, ONE TEST and ONE DAY at a time. It is certainly overwhelming to think of being a nurse and the body of knowledge that it entails. However, taking it in baby steps is a way to approach it in a systematic way that will deliver the intended result at the end. I myself took all of the prerequisites in the first 2 years. Then I took the core nursing curriculum over the second 2 years. Yes, it took me 4 years to do a 2 year RN program, but I did it in baby steps until I was done. Now, it's been 18 years and I wonder where the time has gone. Never let anyone tell you that you cannot do it. Everything is achievable if you want it bad enough. I am a witness to that myself.
And for our second interview, Violet Argo, RN shared her experiences as palliative care nurse. Nurse Argo has been working with hospice patients for 19 years now. She is also one of the expert nurses in AllExpert.com who is always ready to answer questions about terminal illness and hospice care.
Violet: I have been a nurse for 20 years, practicing hospice and palliative care for 19 years.
Violet: Caring for terminally ill patients is indeed a challenge. When people realize they are coming to the end of their lives, they have many different reactions. Some are very accepting of their prognosis; some will continue to fight until they take their last breath. Sometimes it's not the patient that's challenging, but their families. Some do not know how to let go even when the treatment is worse than the disease.
Violet: It is very rewarding to me to help someone who is suffering to get their symptoms under control. For example, if I go to see a patient for the first time and find them in severe pain, or having severe nausea and vomiting, or some other terrible symptom, being able to help them relieve that symptom quickly and allowing them to get some rest is very rewarding to me. I can't stop the dying process but I can help them to have as smooth a road as a possible to the end of their lives.
Violet: My most unforgettable experience in a hospital, was to see a patient who had less than 24 hours to live been treated with blood transfusions and chemotherapy and knowing I could do nothing to stop this craziness. I would've wanted to allow her to have a better ending to her life. She could have spent her last 24 HRS at home with her family and not in a hospital getting treatments that would do her no good.
Violet: I love technology, especially electronic documentation. When nurses document electronically, their coworkers have access to the patient information instantly. There are less (fewer) mistakes in their documentation, and of course it's much easier to read when people have very bad handwriting like I do. I have also seen much advance in things like identifying patients when giving them medications or treatments by using electronic devices. Many electronic devices have made nursing more accurate, and decrease errors in treatments and medication administration.
Violet: I am currently in management, I'm scheduled to work 8 hour days, with no weekends or holidays, but of course I work as many hours as I need to in one day.
Violet: To become specialize as a hospice and palliative care nurse, you have to take a test in order to become certified it's about $400.
Violet: I did not encounter any difficulties while accomplish the course or my career.
Violet: Becoming a house on some palliative care nurse is a specialty. You become a registered nurse a first or a license practical nurse first and then you get your certification.
Violet: I worked on oncology for about a year after graduation, and I did Home Health for about a year there is nothing like hospice and palliative care nursing.
Violet: In order to work in a hospice and palliative care setting, you have to be comfortable with your own mortality. You have to be willing to accept, that the patients you are caring for have a terminal illness and limited amount of time to live. You have to be able to work independently; you have to have an extremely good assessment skills and critical thinking skills. You have to have strong empathetic feelings, and you must love people, you must be able to meet people where they are, you must remember that it's not about you it's about them. I teach new employees the concept that working for hospice is allowing patients to do it their way, it's their last dance and they have invited us to participate, we must allow them to lead.
