Welcome Nicki Edwards.
It’s 6:45am and I’m in the staff room waiting for my shift to begin. Other nurses arrive. Some, like me, are morning people. Others grunt and mutter their greetings. They need coffee first. Someone asks about my latest book and a discussion ensues about who will be the inspiration for my next hero and heroine.
This morning I have been assigned two patients. There’s nothing difficult about either of them. Both are hemodynamically stable (their blood pressure, heart rate and temperature etc. are within normal limits) and both should go to the general surgical ward later that morning. This means I’ll get two post-op patients. A busy day.
My first patient is a man who had part of his bowel removed two weeks earlier. After a night in ICU he was discharged to the ward, developed sepsis and was readmitted to ICU via theatre. I looked after him when he was intubated but of course he doesn’t remember me. I stick my head in his room. He’s sound asleep and I don’t wake him. I tell the night duty nurse I know his history and she just gives me a quick update on his progress. Other than low blood pressure, he’s fine.
The other patient is buzzing, asking to pain relief. He had bilateral knee replacements and required an ICU stay for pain management. I introduce myself and take handover. While re-educating the patient about using his PCA – patient controlled analgesia – I check all the equipment is working and the alarms on the monitors are set correctly. I also check the IV fluids and the analgesia in the pump.
While moving around the room, I chat to the patient. I work in a big hospital but in our city there are only three degrees of separation and I often know my patients. If I don’t, I find that by asking a few questions, I can form a quick connection. My favourite question is: ‘What footy team do you barrack for?’ This always gets a patient talking.
I begin my assessment on the knee replacement man starting with questions to assess his pain level and conscious state. I check his pupils, and perform neurovascular obs. All normal. I check his circulatory system, checking temperature, blood pressure and heart rate among other things. His IV fluids run out and I find the order and hang up another flask. Then I listen to his chest. It’s quiet in the bases of his lungs and I remind him of the importance of deep breathing and coughing and the risk of pneumonia. I show him how to use the incentive spirometer to help expand his lungs.
I assess his abdomen. It is soft and there are bowel sounds. Good. His urine output via his catheter is low. It’s been borderline all night. I make a mental note to flag that with the doctors when they do the round.
I like to write my notes early, but a buzzer sounds and I check my other patient. He’s awake and his stoma bag has exploded. Everywhere. He’s mortified. On the plus side, at least his bowels are working, but I kick myself for not checking if it was full. Twenty minutes later he’s cleaned up and sitting out of bed. I’ve put fresh linen on his bed even though I expect he will go to the ward. I return to the other patient in time to record his 0800 observations.
There’s a commotion at the nurse’s desk. The internal medical emergency phone rang and I hadn’t even heard it. A ward nurse wants his patient reviewed by the ICU doctors. She’s barely conscious with an elevated respiratory rate, a low blood pressure and a temperature of 39.
I go back to my patients but keep an ear on the conversations at the desk. The doctors need to intubate the patient on the ward. I overhear something about a possible bleed on her brain and a discussion about tubing her then transferring her to a larger hospital. We don’t look after neuro patients. The nurse looking after the patient doesn’t have the qualifications to care for a ventilated patient and the patient is in a room not set up to take ICU patients. And ICU is full.
The nurse in charge asks if either of my patients are ready for the ward so they can bring the sick patient into the ICU. I decide the bowel surgery guy would be easier to move but when I go into his room he’s vomiting. I clean him up again and assist him back to bed. His blood pressure plummets and his legs crumple beneath him. I yell for help and colleagues rush in. The nurse in charge informs me I need to go to the ward to help the doctors tube the patient now!
I wash my hands, leave the mess behind and bolt out of ICU. It’s only 8:30am.
On the ward I find more chaos. A doctor is keeping the lady’s airway open delivering oxygen via a bag valve mask. One nurse is setting up the airway trolley for intubation. Another nurse rushes in and hands me syringes of propofol, fentanyl and midazolam – all drawn up, labelled and countersigned – before racing off to find IV pumps and poles. I check the drugs and lay to them to one side.
The tiny room is packed. One of the doctors is trying to put in an IV line. He’s had two unsuccessful attempts already. I try and miraculously hit the vein first go. I want to cheer, but don’t. My ED nursing experience comes in handy in ICU.
Outside, a crowd is gathering. The patient’s tearful sister is being looked after by two nurses and a pastoral care worker. Orderlies stand waiting to transfer the patient’s bed into ICU once she’s been intubated.
The ICU Consultant’s calm manner rubs off on all of us. We take a deep breath and exhale slowly. We run through checklists. Does everyone know what their role is? Yes.
Moments later the lady is sedated and a tube is passed down her throat and connected to the ventilator. I fiddle with the buttons to make sure she’s breathing properly while the doctors clean up. Within minutes the orderlies swoop and the bed, piled high with equipment, is wheeled into ICU.
While I’ve been gone, my colleagues have sent the man with the knee replacements to the ward, cleaned his room and taken over the care of my other patient without question or complaint. It’s all about teamwork.
My stomach growls and my head reminds me I needs caffeine. I check my watch – 9:15am.
The ICU Consultant looks at me and grins. “I’ll bet this makes it into your next book.”
He’s spot on.
Nicki Edwards is the author of The Peppercorn Project, published by Macmillan Australia, RRP $29.99