A Day in the Life of An ICU NurseFeb 3, 2017
Interested in starting a career in nursing? There’s no better way to know what to expect in the position than to hear from someone in the field. Matthew Anderson, an intensive care nurse at University of Utah Health, joins The Scope to describe what his daily schedule is like as an ICU nurse and what he finds most rewarding in his work.
Interviewer: Considering a career as a nurse and you want to know what the job's like, the day to day, like a virtual job shadowing experience? Well, we've got that for you next on The Scope.
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Interviewer: The best way to find out what a job is like is to actually find out from somebody that's actually doing the job. If you're wondering what it's like to be a nurse, Matthew Anderson is a nurse at University of Utah Health Care. Thank you for taking the time to explain your "typical day." I put that in air parentheticals because I imagine there's no real typical day, or is there, in nursing?
Matthew: No. Every day is unique.
Interviewer: All right. How long have you been in nursing, first of all? Let's start with a little background.
Matthew: I graduated in 2013 so it's been about two and a half years.
Interviewer: All right. Are you in a particular specialty?
Matthew: I'm in the resource ICU pool so I float to all of the ICUs in the University of Utah system, as well as the ER and the cath lab.
Interviewer: Okay. At the beginning of your day, you don't know where you're going to go?
Matthew: No. Well, the cath lab, I'm PRN there so I know if I'm going there. I'll be pre-assigned to units sometimes. I call in every morning at 5:00 a.m. to find out where I'm going. I could plan on going to surgical ICU. I call in and, "Oh, you're going to burn," or, "You're going to the ER." It varies every day.
Interviewer: All right. Give me a brief description of your job, then. What are you ultimately responsible for in your role?
Matthew: As an ICU nurse, I generally have one to two patients that I'm assigned to. It depends on the acuity of the patient. I'm responsible for executing the orders for the day, taking care of the patient. If they transport anywhere, going with them there. Ultimately, I'm responsible for that patient, making sure protocols are followed, medications are given on time, procedures are done appropriately, etc.
Interviewer: Because these patients have more needs, is that why you only have two patients each day?
Matthew: Yeah. They're generally . . . intensive care units are generally very sick. I can have two patients that are both on a ventilator. If I just have one patient, it's generally because they're on continuous dialysis or something like that, that requires a higher acuity. They might be on multiple medications to control their blood pressure so I'm titrating those medications and stuff. It just depends.
Interviewer: And those two patients would keep you pretty busy during the day.
Matthew: Oh, yeah.
Interviewer: Okay, all right. What are some of the other things that you might do during a typical day in your role?
Matthew: I generally wake up at 5:00 a.m. I call in to the staffing coordinators to find out where I'm going. I call in and find I'm going to surgical ICU. Then, I get ready. In ICUs, we have a safety briefing. We meet in a room together. We kind of talk about the patients. The charge nurse [inaudible 00:02:38] all the patients. Then, we get our assignments and we go and get a report from the off-going nurse. Then, the day starts.
The morning on a day . . . I work pretty much all day shifts. Day shift, the busiest time is the morning. That's when you're doing your first assessments. You're really getting the baseline of the patient because you haven't met them before then. Sometimes, since I float around, I don't really have a lot of continuity of care. If you work on a unit, you might have cared for the patient multiple times before. For me, it's generally getting . . . this is my first time seeing the patient. Then, I'm giving meds. Then, just kind of the day goes from there. If they have to travel to the MRI scanner, CT scanner, X-ray. If they're intubated, that's a whole production. You've got to get the respiratory therapist involved. You've got to get transport there. That can set your whole day back just on transport.
Interviewer: You coordinate all of that.
Matthew: Yeah absolutely. The [HUC] kind of helps with that. Then, bathing the patient. Doing any sort of procedures for the patients. Depending on the ICU, you have multiple assessments throughout the day that you're doing. You're documenting vital signs. You're checking their intake and output. You round with the doctors and kind of go over the plan. If they write new orders, you have to implement those orders. There's kind of one thing after the other.
Sometimes you have a little down time. It just depends on the day and how sick your patients are and everything like that. Yeah, it can be busy nonstop because of admits, discharges, travels. Even just the regular care of bathing your patient, medications and stuff usually takes up most of your time. Most days are pretty busy. Keep you on your feet.
Interviewer: Yeah that sounds really busy. You mentioned you get to collaborate with some of the physicians. Who do you get to collaborate with and how rich is that collaboration?
Matthew: We do multi-disciplinary rounds. Some units have more people involved than others. For example, on the burn unit, they have a conference room they sit in. You have your dietitian there. You have your physicians there. Your attending physician since we're a teaching hospital, you have your attending physician. You have your residents. They have a nurse practitioner there as well. You have your social worker. You have your charge nurse. You just kind of go through everything.
In most units now, they're actually doing nurse-directed rounds because a lot of times it seemed like before the resident would present the patient and then you'd be like, "Actually, this isn't right. Oh, this is different now." You'd have to update about half what they said. Now the resident will generally do the history and kind of introduce the patient and then the nurse will present all of the systems and what the patient's actually doing because that's the most recent u-to-date report of the patient. It kind of [inaudible 00:05:07] things.
Then, you can also, just right then and there, say, "This is what I need." You list off your few things that you see that you need and recommendations that they order. Yeah, it's really good. We're really a team and they ask for my input, what I think is going on with the patient. It's really kind of a collaborative thing. You have your dietitian and your pharmacist. It's just a really awesome interdisciplinary team there that can make the best decisions for the patient.
Interviewer: Yeah, it sounds like you're not just taking orders. You're actually very actively involved in caring for the patient.
Matthew: Yeah, absolutely.
Interviewer: Yeah, that's awesome. What makes your work environment different here at University of Utah Health Care compared to maybe if you were someplace else? Do you have any idea of that?
Matthew: The staffing here is great. I know some places, they can kind of try and cut corners and save money with maybe not having as many HCAs or something. I feel like we have really appropriate staffing. The RN to patient ratio is generally very good as well as the HCA to patient ratio is generally very good. You have help when you need it. Sometimes, actually, we joke, especially in the emergency department, that sometimes you have too much help. You have a trauma I that comes in and you just there really only should be five or six people involved directly with that care. You have everybody and their dog wants to come watch. You say, "Everybody that's not involved in the care, step across that line and let us do our job. You can watch, but get back over there." Sometimes you have too many people around.
The teaching environment is definitely different. When we have new residents that come around in July, you really have to tell them what to do because sometimes they're like little . . . some are really good and some are like little, lost puppies. You're like, "You should order this and this and this." And they say, "Okay. Yes, sir."
Interviewer: You're kind of in charge in that situation of the teaching of the new doctors.
Matthew: Yeah, absolutely. The attending physician ultimately is, but the nurses keep them in line, for sure. I actually had a friend who was doing his ICU rotation as a resident. He says the nurses determine the outcomes. It's not the doctors. That was in his . . . Obviously, it's a collaborative thing. Especially with those newer doctors, the nurses need to know their stuff and keep them on task for sure and keep them orientated. If something's not right, you say, "Nope, I'm going to talk to the attending physician. That's not right."
Interviewer: Yeah. What is your favorite thing about your job?
Matthew: The patients, absolutely. That's the reason I'm here is to work with patients. I've had pulls to go into management, but I want to stay at the bedside. I want to stay clinical and work directly one-on-one. Behind every door, there's a story. It's amazing, kind of what you can learn from each individual patient. At the beginning of the shift, I've never met this person before, but within a few hours, I can be holding their hand and crying with them, especially if it's near the end of life or just kind of just listening to the spouse maybe if the patient's not responsive and just kind of talking to them and just really being compassionate, talking to them. That doesn't happen every day, but every day, I get to work one-on-one with that patient and have direct contact with them and hopefully alleviate their suffering. Sometimes, I have to do painful things. Really, just being there to try and be the best nurse that I can to help them heal the best way that they can.
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