01.08 Day in the Life of an ICU (Intensive Care Unit) Nurse

Hey guys, in this presentation we're going to talk about a typical day in the life of an ICU nurse. So let's get started day in the life of an ICU nurse. Honestly, it really starts out with, depending on the acuity of the patients, if you have, two simple patients and neither one is neither one of them is on a vent. Hey, life is good, but for the most part that's not the case. But the acuity of the patient really makes a big difference. I'm a nurse in the ICU, we'll provide care to critical patients and these patients are usually on pressors and a vent and sedatives. And so it's pretty intense. Prioritizing care and critical thinking is imperative. If you don't do this and you don't prioritize your care, again, you are all over the place. And then this is where it just doesn't help in your day will not go smooth. 

So this is an example of my day. Okay. So I usually work in a cath lab and I work in CV ICU and, when I go to CVI ICU, this is what a typical day for me is. I work day shift. So I get there around 6:40 ish get report. And then once I get report, usually we do bedside report, sometimes we give report to each other outside of the room. And then we walk in the room, introduce ourselves to the patient and the family and just kind of look over the patient together so that the report is accurate from night shift to day shift. And then once I'm through with that, I do a complete head to toe assessment. And again, I know you guys have learned all this but I had to tell okay - , Perla, lung sounds, pulses, reflexes, muscle strength, everything you name it and it is a complete head to tell her assessment. 

And this is where you see also check any drains that your patient has, any, any catheters, any N G tubes, O G tubes, if they're on an event check to see the settings. And I'll come back to that in a second. But if they're on event and they have a knee T tube, check to see where, how it is, like where it is at, the lip check to see any, if they have a chest tube, check your chest tube, check the level to see where the drainage is, anything, anything that your patient has, look at it. If they have an art line, check your art line, check your wife for, make sure it's leveled. If they have a central venous catheter, check that CVP pressure. Anything. Again that is attached to your patient. Check your transducers, make sure that they're leveled everything from head to tail. 

If you go from head to toe, hopefully you won't miss anything because you're checking every system. And then if they're on a vent, check the vent settings. Make sure those settings are to the correct settings that they're supposed to be and that you don't walk in and they're just all messed up. Always check your band settings and, check labs. K. so after you've assessed your patient and you know their baseline, do you know the condition that they are? Oh, I forgot. Make sure you check any infusions. Okay. Are they on any pressors? Are they on Livo? Are they on propafol? What medications are they on? You've got to know this. You got to know what the, what the rate is. Got to know. Got to know your vitals. It is just imperative that you know all this. As soon as you see those patients, after that, check the labs. 

Check your ABGs, especially if they're on event. Find out when you need to do another one and what the most recent one is to see if there's any event changes that need to be made. Once you check your labs, check to see, check your orders and your protocols. Do you have a potassium and a magnesium replacement protocol? If that potassium is 3.4 well you're going to have to replace it. If that mag is 1.6 you're going to have to replace it. So check your protocols, check your orders to see your medications that you gotta give to see if there's any labs, any tests, anything in that morning. Basically, you want to make sure that there's no labs that night shifts. Should've gotten or day shift, whatever shifts you work, anything emergent that you got to do right away. Now in my ICU, we document an assessment initially and we do vital signs every hour or every 15 minutes if they are an on any pressors, any pressors, any sedatives, anything like that, we do Q 15 minute vital signs. 

If not, then we just document, them hourly. But if they're on a vent and if they're nice to you, more than likely they're on something. So this goes off all the time. If they're on an art line, you get that blood pressure. And then after you've assessed your patient, you checked your labs, you checked your orders, you make sure there's no Medicaid, no nothing that needs to be done right away. You check your protocols, make sure you don't need to replace anything, then, administer your daily medications, prioritize care depending on the patient needs and status.If you have a patient who is kind of critical at this moment and you have to titrate your pressors, well that's going to be your priority as opposed to trying to say, Hey, I got to give some meds through the O G tube because they need Protonix or whatever. 

Well, that's not a priority right now. Keeping them alive and maintaining them hemodynamically stable, that is a priority. So prioritize your care. So throughout the day, so this right here, the previous slides, that's just in the morning, that should all be done before nine o'clock. This right here is throughout the day you're constantly checking for new orders. Usually most people that are in ICU, they have an intensivist, they have a cardiologist, they have a renal doctor, they have a nephro well nephrologist, same thing. They have a urologist, they have a neurologist, they have several different doctors that come to see them. And guess what? For the most part, every single one, every single one of them wants to write an order. So constantly check to make sure that you don't have any new orders. Assessments are documented every four hours as nurses, we assess throughout the day. 

When you walk in the room, you're always assessing. But a complete head to toe assessment must be done in documented every four hours. Our times are usually seven, 11 and 1500 and then 7:00 PM. And then that shift does theirs again follow up on protocols or any labs. So if you had a potassium replacement and you had a potassium of 3.2 and you gave some potassium, usually you gotta redraw that lab a few hours after you gave the potassium. So follow up on that. You don't just get to say, yeah I replaced that potassium but I didn't retry it. Nope. Got to follow it. Follow up and I see you, we draw our own labs and we send it downstairs. So that's another big one. We don't have the lab come up to dry it. We do our own. If your patient's H and H was low and you gave blood, make sure you follow up on that. 

Make sure that that hemoglobin went up after you administered blood. If they're on event and you did some ABGs and you did some bed changes, find out when another blood gas needs to be drawn. Okay? So this is something that you do continuously throughout the day. If they're on event, then you got to prevent a pneumonia, the ventilator assisted pneumonia. I know y'all have heard of this. So on the vent, prevent it. Okay, how do we prevent that? Well, we've got to do some oral care. We got a section, we got to turn them. We have got to make sure that you have with the inline section that you're constantly suctioning them. Get those secretions out, make sure that you prevent that. This is done frequently either by the nurse or the respiratory therapist. And usually if they're on a vent and they're getting some type of feeding, they're constantly going to the bathroom with some pretty loose stools. 

So clean them up in ICU. Every now and then you might have a tech that'll help you or a CNA, but you don't want to just send to CNS in that room with the patient on the, on pressors and on a vent and has chest tubes, OG tubes, art lines, CFPs, you know, you want to go in there and help them. So you're constantly cleaning and bathing throughout your entire day. So again, more things that you did throughout the day. Monitor and document and take an output. In the ICU, I work at intake. We do that every hour. So if it's from an Ivy fluids, if it's medications, if it's from feedings, whatever it is, if they're not on event and they're able to take PO, well, whatever they drink every hour. If they are ICU status, it needs to be documented. Same with output. 

So if they have a chest tube, if they have an O G tube or an NG tube, if they have a catheter, if they have any type of drain, anything, we have got to document that every hour. Okay. You got to know, are they bleeding too much? Do they have too much output from that chest tube and their recent heart, a fresh heart. You got to know how much this, this will help you determine if they are having way too much output and if you're erasing them, of course as we'll help, you know as well. So in our ICU we document and take an output every hour it, the patient must have a test done. The RN must go with the patient. If their ICU status, they can not go by themselves or with transportation. So if you have a patient on event with six different drips going and you got to take them to MRI, yup. 

You better get respiratory in there. You better get a tech, you better get another nurse because you have to go downstairs to MRI with the patient. Can't just send them without you. And if you have two patients, somebody better go watch your other patient. Again, more things throughout the day. We deal with physicians. I remember a few slides ago I told you about five, six, seven different physicians. Yep. Gotta deal with all of them, deal with families, deal with any other department that's taken care of that patient or just providing some type of care. Usually it would be respiratory, occupational therapy, physical therapy lab, case management, whatever. You have to deal with all these people as well throughout your day. And then at the end of the day, that was a little exhausting, wasn't it? This is where you can go pee, hopefully you Pete at some point today, but if you have not, Hey, it's six o'clock and night shifts should be getting there soon. 

You're almost there. Hopefully you have eaten, if not, go get a little snack before you leave. And most importantly, make sure that all your documentation is done in that all your labs and medications have been administered and completed. Try to not, I mean there are days that night shift gets there and I've been like, look, you're going to have to do this lab because I've drawn about 10 of them and I'm behind. So nursing is 24 hour care, but don't be the nurses constantly leaving things for night shift to do or day shift. So always make sure, always go back and double check your orders and make sure that you have had everything done. If you couldn't get it done, at least let that oncoming nurse know that you couldn't get it done and it fell. Please take care of it. Okay. And, make sure that you give an accurate report. 

Again, you'll give report and then you'll go do a bedside report so that they can lay eyes on the patient so that your accurate report matches what the patient looks like. And once you've done all this and you can leave, this is my thing. Sometimes at the end of the day, last week I was in CIA and I did not get out until almost nine o'clock because it was horrible. You leave with sometimes and you are questioning your life choices and it's like, why did I become an ICU nurse? Why did I do this? You walk out, you clock out, you walk to your car, which at my hospital it's about two miles away. We have a bus. Yes, but sometimes it's faster to just walk questioning why, why, why, why, but guess what? Then you get in the car and then you have a moment and you remember why you do this. 

You do this because you are a bad ass critical care nurse that saves lives and loves every second of it. And this is why everything that I just shared with you guys on all these previous slides, this is why it's worth it because when you leave and you are going home and you're like, you know what? They didn't die. I saved alive. I took care of the vet, I took care of those drips and I did it all in. This patient remains stable. Yo, you're a badass critical care nurse and this is why you do it. I hope this little lesson has helped you guys and gives you a basic understanding of the life of a critical care nurse or an ICU nurse. So I hope that you guys have enjoyed it and make sure that you guys go out and be your best self today. And as always, happy nursing.