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Veteran ICU nurse Bobbie Wiles, RN, serves
as a preceptor to incoming ICU nurses at Banner
Mesa Medical Center in Mesa, Ariz. |
DeaAnn Martin, RN, BSN, CCRN, can’t talk right
now. A respiratory technician has just arrived to help
hook up the BiPAP ventilating system to one of Martin’s
patients.
“Excuse me a moment,” Martin says, darting
to the bedside of the man wheeled in two hours earlier
in her coronary care unit at Presbyterian Hospital of
Dallas. Yesterday, the man checked into the hospital
for a seemingly minor breathing ailment. Floor nurses
discovered he had removed his oxygen mask during the
night and rushed him to the ICU, where now he’s
unable to exhale on his own.
“He was a little bit confused, and we’re
not sure of the reason” he removed the mask, Martin
says, returning to the nurses station rotunda in the
center of this third-floor ICU. “The BiPAP [bi-level
positive airway pressure] buys him some time before
we have to put him on a ventilator.”
Martin, as usual, is busy this morning. A charge nurse
in the unit, she has only a few moments to write down
updated chart information on the patient before she
focuses on a potential DNR case across the room. Meanwhile,
a desk secretary tells her about a pharmacy order change,
and another nurse runs by to update Martin on a third
patient’s status. Cardiologists and other physicians
are roaming the unit, and could call for Martin’s
assistance at any moment.
Over the noise of beeps and alarms from 10 different
rooms, Martin gladly accepts a coworker’s offer
to bring up a soda from downstairs. “I’m
not sure when I’ll get a break to go down there
myself,” she says.
Multitasking and quick thinking are the hallmarks of
a critical care nurse like Martin. Patients who could
be just minutes from death don’t always have time
to wait for the physician, so nurses must work with
their eyes, ears, and instincts wide open. They are
the gatekeepers for patients’ well-being in the
ICU, possessing the educational and technical savvy
to address vital needs along with the personal skills
to hold a hand or reassure a panic-stricken patient.
Striving to do this job more efficiently and more safely
has been the focus of critical care nurses for decades,
and recent changes in the field have stepped up those
concerns. Moving toward evidence-based practice, building
up specialties, and matching care to an older, sicker
patient population are presenting fundamental shifts
in the profession for critical care nurses.
“The need for nurses to be much more in tune,
much more educated and technologically savvy ... has
changed the environment so much,” said Justine
Medina, RN, MS, practice and research director of the
California-based American Association of Critical-Care
Nurses (AACN). “I think some of our old models
of the way we’ve done things in the hospital are
being stressed to the limit.”
New rules
In Faster, his best-selling study of modernity and
time, New York Times science writer James Gleick explained
the “paradox of efficiency” in the airline
industry. Deregulation, hub systems, and computerized
scheduling allowed carriers to squeeze in more flights
and more passengers, but simultaneously introduced problems
of complex pilot scheduling and shorter delay allowances
that were born as a result of the new structure.
This catch-22 is somewhat parallel to critical care,
as nurses see both the miracles and the consequences
of health care advancement.
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