I started my nursing career working on a medical / surgical floor at Norwalk Hospital back in 2011. After a year on that floor, I was ready to move on to the ICU. I decided to leave Norwalk to go work at St Francis Hospital in the Medical/ Surgical ICU. I stayed there for almost two years then decided to take a travel nursing assignment in Southern California. As a travel nurse, I had the opportunity to work in several different ICUs on the west coast until signing on as staff at one of the hospitals. In 2018, I left bedside nursing for two years to focus on personal training and social media. When the pandemic hit this past spring I decided to head back to the ICU at my old hospital. I worked primarily in the COVID unit for the first 5 months of the pandemic.
So what does a typical day looks like for a nurse in the Intensive Care Unit?
The day starts off in the break room with the rest of the day shift nursing staff and charge nurse. We have our morning huddle to go over anything important for the shift or upcoming weeks at work. This is also the time where we pick up our patient assignment, grab our work phone for the day, change our scrubs if we’re working with COVID patients, and put our lunches away.
Next we head to the nurse’s stations for report.
BEDSIDE REPORT
We usually receive report on 2 ICU patients, unless one of the patient’s is more critical and is a 1:1.
Report is usually given at the bedside. However, things have changed a little bit with COVID. We don’t give and receive report at the bedside with COVID patients.
The information discussed the report in an ICU usually consists of the following:
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- Name, attending and consulting physicians, Code status, allergies
- Precautions like fall, seizure, infection prevention, bleeding
- Chief complaint- why they’re in the hospital
- Past medical history and current status
- Important events that have happened during the hospital stay
- Assessment findings by body system
- Neuro, Cardiovascular, Respiratory, GI/ GU, Skin, IV access
- Important lab values
- Any psychosocial, family, and support system concerns
- Important medication considerations
- Weaning off vasopressors or sedation medications, electrolyte replacements, blood product administration, PRN meds needed
- Pain management and goals
- What are the goals for this shift?
During the report, I usually check a few things at the bedside:
- make sure my drips have enough volume in them for a few hours
- when tubing is due to be changed
- If my patients need to be cleaned up and changed
- check the alarms on the patient monitor and changed them as needed
Once I obtain a report on all of my patients, I take a second to figure out which patient is the most unstable and if they need something right now
If both of my patients are ok for the moment, I sit at the nurse’s station and look up orders, when meds are due, notes from doctors or anyone who has seen the patient, recent vital signs, morning labs, and test results. Then I make a to- do list for each patient.
PATIENT ASSESSMENT
After I get everything I need, I head into my first patient’s room. I say hello to the patient and anyone else in the room and then complete my patient assessment and check out any equipment, lines, drains, and the monitor, and then give meds (IVPB, by mouth, through a feeding tube, IVP/SC/IM). At the same time, I’ll tell my patient and what i’m doing it whether they are awake or intubated.
Once I see this patient, I head in to see my other patient and follow the same process.
DOCUMENTATION
Assessments:
- A full head to toe patient assessment is done and charted every 4 hours
- Sometimes assessments may be required more frequently. For example, most neuro patients require a full neuro assessment every hour in the ICU
- Vital signs, pain, and intake/ output are documented every hour
- Sometimes vitals every are charted every 15 minutes depending on the type of medication drip they are on.
- If the patient is in restraints, that’s charted on every 2 hours
- Turning/ repositioning is also charted every 2 hours
- Care plan, education, and note is done at the end of the shift. Notes can also be done if something important happens during the shift
CONSTANT MONITORING
ICU patients can change quickly. Therefore as an ICU nurse, it is our responsibility to keep an eye on them by checking the monitors and listening for alarms from ventilators, bed alarms, IV pumps, or the monitors.
ROUNDING
Rounding is typically done once per shift. For day shift, we round at 11am. The primary ICU nurse, ICU physician, charge nurse, repository therapist, chaplain, registered dietician, wound care nurse, infectious disease, pharmacist, and case manager all attend rounds during the week. On the weekends, it’s usually just the primary nurse, ICU physician, charge nurse, and pharmacist.
Rounds are a good time to establish a plan for the day for the patient and ask the ICU physician any questions you may have.
FINISHING UP
After 12 hours it’s finally time to finish up and give report to the oncoming shift. Sometimes, I feel like I’ve ran a marathon around the unit, and then get to report and feel like it looks like I’ve done nothing all shift. It can be a little defeating at times. But, what matters is that all of the tasks that needed to get done for the patient are completed.
If I took care of COVID patients, then I change out of my dirty scrubs, put on my clean ones, clean my shoes, and anything I used during the shift.
Then I usually book it out of the hospital, especially if I have to be back at 7am the next morning. It’s important for me to get home right away so I can shower, take care of the dogs, eat dinner, prepare my work bag for the next day, and just relax before another busy day in the ICU.
