Updated: Oct 29, 2020
I'm Gerard and currently working as an Adult Intensive Care Unit (ITU) nurse in one of the NHS Trusts in the Midlands. I have worked as an Emergency Department nurse in the Philippines from 2012 and started my UKRN journey in Leicester, UK in 2018 as a staff nurse in the Accident and Emergency Department. Later on, I was given the opportunity to move to ITU department where I'm currently based.
What’s your typical day like?
Just like any other NHS hospitals, we do 12 hour shifts here at UHL ITU. On any shift, I start with introducing myself to the patient (if applicable), then proceed on doing bedside and emergency checks, and taking patient's observations. Part of my duty is to also check all the lines, tubes and devices attached to the patient. It is also important to have a medication review and to check the doctor's orders from previous shifts at this point.
On long days, I start preparing my morning medications, or prepare to give my patient his/her wash. By this time, the doctors would already be doing an initial patient review in preparation for the Ward Round. During night shift, I normally have my patient reviewed for any updates to the plans, or focus of care overnight. After all of the medical and surgical teams have visited the patient and updated the plans/orders, most of my shift will revolve around monitoring my patient, carrying out orders for treatment, medication and/or diagnostics, adjusting and refining parameters on your equipment (i.e. ventilators, dialysis machines, ECMO, etc.), and making sure your patients are safe and secure. In my unit, ward handover happens at 0730 or 1930, and patient handover happens shortly thereafter. So now it's home time. A chance for me to rest, recharge, and prepare for the next battle.
Why did you choose this area of nursing?
I was primarily drawn to apply for ITU because of the chance to experience handling various machines and equipment. Little did I know that there was more in store for me than I could've imagined. In A&E, I just instinctively respond to whatever case that's put in front of me. It's basically "take them in, sort them out, and ship them out". Here in ITU, I've gained a new perspective of the patient care continuum. I am able to be more of an advocate for both patients and relatives as they receive ongoing care. In my specialty, I am able to get to know my patients better, learn more about their history, and technically be more caring as I now have the chance to spend a longer period with them.
What does it mean to be an ITU nurse?
In working as an ITU nurse, you become a part of a patient's "see through" phase. Regardless if they come from A&E, a ward, from home, or from a different hospital, you, as the nurse in Intensive Care, will be responsible for seeing them through their toughest of times. These patients are in your unit for a specific reason. They need more support, they need your "intensive" care during the time when they are most vulnerable, or when they cannot speak or act for themselves. With the help of medications and machines, you (as the nurse) will be the agent to bring your patients back to health, and eventually prepare them to be reintegrated to their normal life as healthy as they can be, as independent individuals.
What qualities and skills does an ITU nurse should possess and acquire in the process?
Foresight. That's what I think is the most necessary in ITU. You must always be able to think ahead and be prepared for what may happen to your patient within your shift. Critical thinking and alertness are essential to be able to respond to any actionable results or events you will encounter at any time. One must also have intestinal fortitude in dealing with the most difficult to most heart-breaking scenarios in the day-to-day life of your patient, their relatives, your colleagues, and YOURSELF.
How were you able to get this job?
Whilst working in A&E, i saw a "job swap" post in our hospital's intranet. Since I already had years of Emergency Service experience under my belt, I thought of having a different experience. And since I'm already working in a different country, I envisioned that ITU would broaden my horizons altogether. I contacted the ITU Matron via email, and the team was very receptive and responsive of my queries. In less than a week, I already heard back from them and that they were very happy to have someone like me onboard. The ITU ward manager and recruitment lead then contacted my A&E Matron and Line Manager, and good feedback was handed over with regards to my performance and reliability. Within a month, I was discharged from A&E service, and joined my new family in ITU, where I have been progressing since.
Do you think you are making a difference as a nurse in this field? How?
At the moment, in my own little way, I believe that I'm contributing and making a difference in my field. Though you can't always expect recognition and appreciation from colleagues in such a busy and diverse environment, it's usually the patients and relatives that make up for it. The letters, commendations, gifts, and praises by the patients and relatives somehow say that I am making an impact to their lives. Moreover, whenever I get a patient discharged or speak to someone who's recovered from being poorly in ITU, it tells me that somehow, I was able to help someone towards making that magic moment of recovery and happiness to happen.
Also, being looked up to by the juniors and hearing comments that I am able to answer their queries and doubts mean so much to me. It gives me great joy to hear them say that I am able to teach them something new, or an easier way. Being a role model for the newer and younger generation of ITU nurses, especially those who are internationally recruited, may be my own way of leaving a mark in my profession.
What are the benefits of working as an ITU nurse?
Being a nurse in this particular specialty provides an individual with a wide range of benefits. Mental toughness, is something that will come to you naturally as you gain experience within the ITU setting. Once you've experienced taking care of patients in Intensive Care, I guess it's safe to say that you will be mentally equipped enough to tackle on cases in different areas. The way you assess patients and treat them both as parts and as a whole will give you skilful insight towards patient care regardless of the scenario. The way you will have to juggle your responsibilities to your patients, to their relatives, and to your colleagues will teach you immense multitasking and prioritization.
Aside from the great pride of being called an Intensive Care nurse, working in ITU may give nurses a deeper sense of purpose as we tackle the surging patient demands especially during this Covid 19 pandemic. Also,in my Trust and possibly with the others, doing shifts in ITU also comes with special rates of pay, as this is a specialized area, requiring a lot of skills from nurses. What are the challenges of an ITU nurse?
I think the main challenge of any nurse in the ITU setup is time management, especially in taking care of patients who need multi-organ support. Managing medicines and equipment for one particular failing organ is a daunting task enough, let alone having a failing heart, kidneys and lungs altogether. For newer or even newly qualified nurses, being exposed to ITU might usually seem to be scary and challenging, but with determination and openness to learning, anything can be achieved.
Management and use of machines and equipment may also be difficult at first for some, but with constant practice and application, everyone will eventually find it easy and as a second nature.
How would you convince other nurses to consider a role in the ITU?
If you are a highly motivated nurse, geared towards improvement in an environment which looks after a wide array of specialized cases, then this specialty is for you. If you are a newly qualified and are looking for a great effort but a highly rewarding job, then you'll have to look no further. Being in ITU gives you the opportunity to practice as closely to most of what you read in your textbooks, but also gives you the chance to innovate, better yourself, and hone your skills in patient care, utilizing some of today's latest and most intuitive equipment available to achieve quality patient care and good outcome. Realistically, it's as close as you can get to the 3 P's. Pride, Purpose, Pay.
About the author:
Gerard Christopher Alex D. de las Alas, RN is an Adult ITU Staff Nurse at Leicester Royal Infirmary.