Do you know that aside from the General ICU/ITU, there are also other specialised Intensive Care/Treatment Units?
Meet Emelyn, one of the very few nurses working as a Burns ICU Nurse in the UK. Know how it is to work in this said specialised unit, from the day to day challenges, benefits and skills needed for this role.
I am Emelyn, a Burns Intensive Therapy Unit (ITU) Nurse at St. Andrews Burns and Plastic Centre Broomfield Hospital. I arrived in the UK last year as a qualifying overseas nurse and was assigned to work in Burns Critical Care. I work part-time as an agency nurse on my days off as well. I’m also an active volunteer to some groups based in our hospital. One is for the “Buddy Scheme'' where I assist newly hired nurses from overseas with anything under the sun and the other is for Macmillan Cancer Charity Pod.
What’s your typical day like?
Like any other Critical Care Unit, Burns ITU is a department where the demand for patient care is at its peak all the time. As a specialised burn unit, we look after patients having Total Burn Space Area {TBSA) of 25% and above with airway involvement, inhalation injury, and skin loss such as Steven Johnson Syndrome and Toxic Epidermal Necrolysis syndrome. We provide services to adults and paediatric patients. Burns ITU focuses more on management and treatment of burn injuries with procedures such as grafting, dealing with complex wounds and complex dressings.
Why did you choose this area of nursing?
I expected to be working in General ITU but found out that I was assigned to Burns ITU. It was not really my choice. At first, I thought this job is all about changing dressings and helping burn patients to shower. But the experience in Burns unit is incomparable to General ITU in terms of patient care because of the specialised interventions that needed to be carried out.
What does it mean to be a burns ITU nurse?
To be a Burns ITU nurse, sharp clinical skills are needed. It includes but not limited to pain management, fluid balance, critical care, the stabilisation of acutely burned patients, trauma recovery and rehabilitation. We look after post-operative patients who undergo skin grafting or skin transplant. We deal with sepsis most of the time since the skin integrity of all the patients are impaired, thus infection is almost always unavoidable. Being in Burns ITU can be quite overwhelming for patients as they stay in the unit until the burn wounds are totally healed. Familiarisation with complex dressing for complex wounds is a must for the role. To be a Burns ITU nurse, it means you also have to be ready to stand for long hours to complete a dressing and during a patient's shower in a negative pressure room with complete PPE. Imagine this...I can actually squeeze my scrubs with sweat after a patient daily change of dressing and shower!
What qualities and skills do a burns ITU nurse should possess and acquire in the process?
I think critical thinking and communication skills are probably the best answer to the question. Being in a burn’s unit is not an easy job, but what made me love this job is the opportunity to learn and the chance given to me to be part of the team. You should be a team player! I need the muscles of all my colleagues to get through the shift. You just have to know when to ask for help and colleagues will be more than willing to give a hand.
How were you able to get this job?
I had an interview for a General ITU nurse when I was in Dubai and thought I would be posted in the same unit. I even made sure that before signing the offer letter that I will be working only in General ITU. They assured me of that. But then, this was not the case when I arrived in the UK.
I found out on my first day that I was assigned to Burns ITU instead. Initially, I was hesitant about the area so I reached out to the Overseas nurse coordinator and explained to her that this was not the post that I signed up for. I started the job with Burns ITU anyway and felt a little difficult to fit in. So I thought, before I got my pin I needed to be transferred to General ITU. Again, I spoke to the Overseas nursing coordinators about my request. I was told that the General ITU here in the UK is far different from the ITU where I used to work and that I will be overwhelmed if I start in General ITU. They also told me that they don’t take new overseas nurses in this particular area.
After hearing what they have to say, I was challenged. I wasn’t really in the position to say at this time that I can do it as I haven’t got my pin yet. This served as my motivation to pass my OSCE. After a successful OSCE and getting my pin, I couldn’t let go of my current job and realised that I preferred to stay in the Burns ITU. I learned to love the unit and the people I work with. I also ended up doing bank shifts in General ITU a month after I got my pin whilst enjoying my role in Burns ITU, hitting two birds with one stone.
Do you think you are making a difference as a nurse in this field? How?
Indeed. This is a very specialised and advanced area and not everyone is given the chance to work in this field. Patients in the burns unit have unique needs. Most of them are in pain, undergo series of surgeries and stay for a long period in the unit. Their conditions are also unpredictable as one moment they are well then the next minute, they are on septic shock. This is quite too much for a patient to take and too much for the families to understand. Some are even in denial of what really is happening. But the whole team is really supportive.
We don’t only look after the patient but their family as well. Since they are not allowed to visit frequently, especially these days with COVID-19, we make sure that we are always there for our patient. We update the families and inform them of the progress on a daily basis. We reach out to them for the benefit of the patient. A burns patient’s journey doesn’t necessarily end in the Burns ITU. It’s a long process until they are discharged from the hospital. Their struggle is even more as the scars will always remind them of the experience. So we make sure they are supported not just clinically but also mentally and emotionally.
What are the benefits of working as a Burn ITU nurse?
I get the chance to work with Internationally renowned surgeons and go for courses such as Burns and ITU courses. Since it’s a special unit, I also had the opportunity to work with experienced and brilliant nurses and learn from them.
What are the challenges of a Burn ITU nurse?
One of the biggest challenges is working in an ISOLATION room. It's difficult to be working in a negative pressure side room with all the PPE for the whole shift. You need to act fast and think critically since you’re alone looking after the patient most of the time. You should know when to press the code button and call for help if needed. Burn patients have complex needs in terms of dressing change. Dealing with traumatized and distressed families is also one of the challenges I felt in the unit.
How would you convince other nurses to consider a role in the burns ITU?
I would say it's an empowering yet enjoyable experience when you’re able to do the things you thought you would never do. Surprise, surprise! Whenever a patient comes into the admission room of Burns ITU, I learn something new and I acquire further skills and knowledge in terms of Burns clinical experience. So, if you like to challenge yourself and learn a very specialised area of critical care then you should come to Burns ITU.
About the Writer: Emelyn is one of the very few Burn ITU Nurses in the UK. Before moving to the UK, she worked as a Nurse in Middle East. Want to know more? Watch her video as she shares her experience working in 2 different countries. Click link.