“In ICU, you don’t get the luxury of feeling tired, running on autopilot.”
I’m a Division 1 nurse working at the Intensive Care Unit at the Royal Melbourne Hospital.
Although my mum was a nurse, it was never something I was interested in doing when I was young. After school, I got into hospitality, working in bars and restaurants. Having a dual Irish passport, I travelled to Ireland and lived there a few years, doing odd jobs – but mainly hospitality.
It was a lot of fun for a while, but eventually, I looked around me and thought ‘Do I really want to be a fifty-year old waitress, working nights and weekends? This is going to get old real quick’. So I came back to Australia.
Mum got me a job working as a medical receptionist at a plastic surgery centre where she worked. My job was to take calls, call the patients with their theatre time, give them surgery information, admit incoming patients.
I found that while I didn’t love the admin work involved, I really enjoyed the interaction with the patients – bringing them in, getting them into their gowns.
Given my hospitality background, I understood that I was a people person, and I like to move around, not be stuck behind a desk.
While there, I asked to see some operations. I got to a see breast implant surgery first. Then a surgeon showed me a trigger finger operation, when they open up a finger. He showed me where the vein and the artery were, and how when you pull the tendon, the finger moved. I was fascinated.
And I thought, ‘A lot of people would find this gross, but I’m really interested, maybe this is what I should be doing.’
So, at 25, I decided to study nursing. I was going to do Division 2, which is a shorter course. But I’m glad my mum convinced me to do the full 3 year degree and do Division 1 to get full registration.
I was one of the oldest students, but I found that was a benefit to me. I was more focused, and determined to succeed – which I did. I worked for the first year in my receptionist job, but then the workload got a bit much, and I quit, living with mum and dad while I studied.
Part of nursing study are placements.
You do several weeks at different hospitals, watching and helping. A lot of mine were rural, which wasn’t easy, as you don’t get paid, but still have to cover your travel and accommodations. Still, they were a valuable experience.
One of the placements was at the Dandenong emergency. That was an eye opener! It was very busy, a lot of drug and alcohol cases. Another placement was in a mental health unit, and a social work placement, visiting mentally ill people living in the community.
I enjoyed learning and experiencing all these new aspects, but I felt myself gravitating towards the faster-paced, more intense work like critical care, or emergency.
I found the slower work in the wards less satisfying, as you had to spread your care thinner amongst multiple patients, as opposed to the one on one care you give in critical.
Once you graduate, you are registered nurse ready for work. However, a lot of people opt to do a graduate year, which most main hospitals in Melbourne offer. This means you are still working as a fully qualified nurse, but the hospital supports you with further on-the-job education to ensure you are not thrown in the deep, end and develop a deeper understanding of medical concepts.
Once you’re accepted into the grad year, they ask you to list your area preferences, say from one to 10, and depending on your past experience and marks you hopefully get into one of your top ones.
Given my goal was to end up in ICU, I put down theatre, cardiac, neurology and respiratory, as these are the main things you get in emergencies.
Now, the reason I put respiratory last was that I hate dealing with flem. I don’t know why! I’m fine with blood, guts, poop and urine – but I hate flem. So I was pretty happy when I got into neurology. Little did I know, that people who have brain injuries often have tracheostomy, which is a permanent breathing tube in their throat – which coughs up flem all day long! I had to learn to deal with that pretty quickly.
My first rotation was at a slow stream rehab. This is where people with acquired brain injuries go to be looked after. So aside from strokes, you get a lot of young people with brain damage from motor accidents or drug overdoses. It was so sad to see these young boys, who had fallen off their motorbikes, with pictures of their younger selves on the walls, lying there looking nothing like they used to be.
My day consisted looking after around 5 patients, which is a lot, but because they aren’t acute, you could take your time. They all needed to be washed, dressed, medicated. It was heavy work. You needed to hoist people into the shower, on their wheelchairs. Majority were incontinent, had tracheostomies, couldn’t talk.
Also one patient per day had to have the full suite of observations performed and recorded: blood pressure, heartrate, all the vital stats.
While it wasn’t the fast paced clinical work I wanted to do, what I took from that job was really good nursing care.
Sure, performing CPR and such might save a life, but it is also very important to be able to wash somebody, give them good mouth care, talk to their families: all these things that can get overlooked when you get excited about doing clinical work.
My second rotation was in a surgery theatre.
In theatres, you can have the scrub scout nurses: they are the ones you see on TV passing the scalpel.
But there’s also anaesthetics and recovery nursing, which is what I did. You get the patient ready for sleep, help the anaesthetist to administer the drug, monitor the patient while they’re under. Afterwards, you supervise their awakening, get their pain under control, check their wounds and send them on to the ward.
Graduation year is not a guaranteed job.
Once you finish, you still have to re-apply for your next job. You can apply for the same ward, or somewhere new.
It’s definitely a lot easier to get a good job after doing a grad year, as it shows commitment and better education. Throughout the year, you’re not just working, but still doing learning units, and there are educators working with you who continually test your knowledge, to make sure that you keep absorbing new skills, not just cruising along on auto pilot.
So your results throughout the year also influence your job application results.
I really enjoyed my anaesthetics recovery job and was considering staying on for a while, but then one of my colleagues said that she was applying to intensive care introduction course after the grad year.
At most of Melbourne’s tertiary hospitals, including the Royal Melbourne Hospital, in order to work in ICU, you have to do a post-graduate in critical care nursing. That’s a lot of time and money, so to make it easier for nurses to commit, there is an ICU introduction course, which is what I applied for.
You can do it for either 6 or 12 months, and it gives you an opportunity to learn the basics of critical care and to see what it’s like. If you decide it’s for you, you go on to do the post grad.
As opposed to say, ward work, or rehab work, critical care is a lot more involved, a lot more autonomous.
You give medications other wards can’t give, you control machinery keeping someone alive, you really have to think on your feet and make big life and death decisions. So that makes the work seem more glamorous, I guess, more prestigious, which makes ICU hard to get in to, there’s a lot of competition. So I was really excited when I got in to the intro course!
Even after my degree, and the grad year, the intro course was a seriously steep learning course. We learnt in units – how to do a full assessment on a critical patient, how to use the ventilator. We did neurological assessments, using machines to measure pressure on the brain.
I did the full 12 months course, as did most of the people who were in my group, as there was simply so much to learn. Now I am halfway through my post grad in critical care.
At the moment, I work four days a week, 8 hour shifts, and I have 2-3 days to study. Once I finish the intense Royal Melbourne Hospital component of my course, I will move to doing the 12 hour shifts, which are the norm for an ICU nurse.
12-hour shifts sound long, but you actually need that time to give your patient proper care.
In ICU, you get one patient per shift to look after. There is a lot you need to do for them, you are performing critical tasks, so you can’t be handing over to another nurse all the time. You might be weaning them off their ventilation, working to slow their heart rate or get the pressure in their brain down. You need the time to do things properly.
Sometimes, if there’s no critical patient, you might get two HD ones – High Dependency, who don’t need intensive care, but still heavy workload. But generally, in ICU, it’s just one. The patients are all very sick, most of them are on machines keeping them alive. A lot of trauma, accidents.
After 2 years in ICU, there’s still much to learn, there are still patients I can’t take because they are so ill.
You might have someone who has a filter, they are on dialysis for their kidneys, they’ve got machines helping them breathe, or their heart to pump. I might be able to look after each of these machines individually, but my skills are not adequate to juggle all three.
Feeling out of depth sometimes is something I don’t enjoy.
I know I’m still learning, but when you’re in a situation you’re unfamiliar with, it’s anxious. There are periods when I’m doing really well, and I feel like I’m getting better, I know what I’m doing – and then there’s a situation that tests your limits all over again.
And I know even the older, more experienced nurses go through that, but still, sometimes I start questioning myself, am I smart enough to do this? There’s so much pressure. I laugh to my partner sometimes that I just want to go and work at Coles, swipe things and ask people about their day.
In ICU, you don’t get the luxury of feeling tired, running on autopilot.
Which is why a lot of nurses do 2-3 days in ICU, and another couple of days in something less critical, like ward work or an outreach program, to avoid burnout.
One of the hardest part of my job are the families. If I have a 22 year boy who flew off his bike and now has this massive brain injury, my job is to look after his broken body, keep him breathing. But when his mum comes in, and is bawling by the bed asking if he will wake up, that’s hard – there is no rule book. It’s hard, especially when you have to give them the bad news.
I used to wonder, ‘Is it OK that I cry? Is it OK if I don’t cry?’
I don’t think sobbing is appropriate, but if someone is really falling apart, and I go give them a comforting hug, I don’t think it’s abnormal to show my own emotion. Sometimes you can’t help but cry in compassion.
I used to see these older nurses who had become quite guarded, and think that they were mean old nurses. But now I realize, that if you are to have longevity in this job, you need to find ways to somehow distance yourself, to compartmentalize.
It does help to vent, to family and to co-workers.
I’m lucky my mum is a nurse, she understand everything I go through. And I’m lucky I’ve worked with great bunch of people, we still often catch up and chat about work and life.
What I like about ICU is every day is different. I like going in, not knowing what I’m going to get that day. In an ideal day, you start your shift with a handover from the previous nurse looking after your assigned patient. Together, you check the drugs and the machines to make sure you’re across everything.
Then I do a full patient assessment, set all the alarms. I check the drug chart to work out when drugs are due. I plan my day out, wash the patient, check their catheters, change dressings.
Or somebody might have a brain bleed, so the patient must remain completely still and isolated.
If they cough, or if you make a noise, the pressures in their brain might fly up, and they risk a secondary brain injury.
You spend the day keep all disturbances around them down, which makes for a slow and quite tedious shift.
But then there’s days where you come in in the middle of some emergency – like the other day, they were trying to intubate my patient when I started, because he was pre-arrest, close to heart attack. Then it’s all hands on deck, action-packed.
I really love the days when I can say ‘I was a really good nurse today.’
And often it’s the little things that you do, like helping a family through a crisis situation, easing their anguish.
Or, recently, we had a patient, and his alarms went off, we all thought he was about to have a heart attack. Everyone was rushing around, getting machines ready, putting pads on him, preparing to save him.
He looked petrified. So I just held his hand, and explained what everyone was doing, telling him he’d be OK. And the next day I went in to see how he was, and introduced myself, and he said, ‘Yes I remember you, you were the one that made me feel like I was gonna be OK yesterday’. And it’s moments like that, that really matter to me and make my job worthwhile.