On the Other Side of the Rails
You are More Than Your Resume
Amanda J. Rose MSN, RN, CEN, TCRN, PHRN
Imagine this: You arrive at your assigned department for your regularly scheduled shift, and soon after you are redirected to the third-floor intensive care unit (ICU). This particular floor has been entirely converted to care for coronavirus (COVID-19) patients. At this moment, in the middle of a global pandemic, despite having no formal ICU experience, you become part of the ICU team. Before my disbelief could consume my attention, I was paired with an experienced ICU nurse and quickly realized this was my reality. My mind was flooded with a mix of emotions and concern for myself and my family’s safety. Adapting to this new change meant that I would be required to perform skills that were not part of my everyday practice, quickly learn the blueprint of the ICU, become part of a team I just met, and face the adversity of COVID-19 that had already overwhelmed our hospital.
I knew that my hospital had an ICU; little did I know that I would become a staff member on this floor. My only ICU experience to date was the typical emergency department encounter—stabilizing the patient and running them up to the unit as fast as humanly possible. Typically, my patients arrived in the ICU with intravenous (IV) lines tangled like spaghetti, the pump and all of its channels flashing red with alarms of occlusion or air in the line, the ventilator warning of high pressure because the patient was not perfectly sedated, and the patient fully dressed in the clothes they arrived in. Sound familiar? As emergency nurses, we are proud that we have stabilized and successfully transferred care. As an ICU nurse, it’s time to fix what’s broken.
Let me clarify any illusions that one may harbor. Up until this point, I had zero formal ICU experience. My resume consisted of pre-hospital emergency care and nearly a decade as a nurse in the emergency department as well as a short stint in the operating room. The ever-changing, fast-paced emergency department did not typically spark an adrenaline rush in me; rather, it had become a comfortable arena. I knew my policies and protocols. I could find any equipment that I needed quickly, and I could recognize subtle alarms and distinguish cries for help through background noise that would overwhelm most new nurses. However, the COVID-19 ICU did create that jaw-dropping, palms-sweating, gut-wrenching nervousness. Although the ICU and the emergency department may be completely different, our ultimate goal of saving lives is the same. As I walked into the ICU, I was quickly humbled. The perceived chaos of the emergency department was nothing compared to the war zone that was an ICU overrun by COVID-19. The ICU had become a battlefield.
Met at the door by management with a 1-page orientation list to be completed as soon as possible, I found an ICU unit functioning at capacity and completely inundated with COVID-19 patients. Pumps cluttered the hallways, pool noodles encased IV tubing, and ICU staff helped each other don protective gear to enter patient rooms, all set to the background noise of continually alarming monitors. The addition of colorful styrofoam pool noodles to my daily care routine was a new and intriguing application. This innovative implementation protected our staff from tripping on IV tubing that decorated the floors of our patients’ rooms. It also created a tubular case to protect the IV connections from cracking as the doors were opened and closed. It was ingenious. What I had seen on the news was reasonably accurate. Donned in our illuminated, oversized powered air-purifying respirators (PAPRs) and reusable, donated yellow cloth gown, I felt like an astronaut visiting the hair salon. Our N95 masks were being reprocessed, and we had 1 surgical mask to wear throughout the day. We had to be grateful for the equipment provided to us, acknowledging the fact that across the world, the same PPE was not as easily accessed. Imprints of our gear left battle scars not only on our faces but also in our hearts and minds. At this point, I realized there was nowhere to run but into my patients’ rooms to help these very sick people. Within 3 shifts—yes, just 3 shifts—I was “oriented” and given an independent ICU assignment for the first time. This day may have been the longest and scariest shift of my career.
With a boost of courage from the experienced ICU nurses beside me, I approached my care in segments to make sure I covered each essential part of my daily care. Medications, ventilator care, repositioning, head-to-toe assessments, drip management, arterial line, and central line management were small parts of the equation. I pieced together a convoluted puzzle by creating my own report sheet that worked as an aid throughout the day. At the end of my shift, I was able to follow the charting system more efficiently, my patients remained stable, and I had learned what priorities needed to be met. I felt like I was a superhero in training. What the ICU nurses didn’t realize was that this is how I envisioned them. They were heroes.
Fast forward: Two months have passed since beginning my assignment as an ICU nurse, and I joke that my experience in the ICU is officially resume worthy. I have cried tears of joy and relief and have been flooded with mixed emotions that have overwhelmed my heart and soul. I have seen successful extubations and have witnessed COVID-19 survivors walk out of the hospital. I have held the hands of loved ones who were actively dying. I have also video-conferenced with families who were not allowed to visit. My time in the ICU was much more involved than my resume will ever be able to accurately portray. The experience I have gained with these incredibly talented and skillful nurses has created an everlasting inscription on my career and practice.
The takeaway: Working in the ICU intensified my understanding of how each unit must collaborate effectively and efficiently to provide high-quality patient care. I never thought that I would become an ICU nurse in the middle of a global pandemic, trying to provide care for some of the sickest patients despite limited research on a virus that invaded our world. Nevertheless, I have networked and met some wonderfully competent nurses, nurse practitioners, social workers, physician assistants, respiratory therapists, anesthesia teams, and physicians to help guide my new practice along the way. My story represents 1 layer of the team effort put forth in our hospital system. There were members on every unit that were put into situations that shaped their careers in various ways. I applaud you all for your flexibility and capability.
We may have lost so many things with the COVID-19 pandemic; however, I can promise you that we have gained considerably more: new skills, new friends, new research, small victories and big, but most of all, an overall new perspective. Remember, you are more than just the list of experiences on your resume—you are a health care provider on the front line.
Amanda J. Rose, MSN, RN, CEN, TCRN, PHRN
Amanda J. Rose MSN, RN, CEN, TCRN, PHRN is a registered nurse with over a decade of experience in in the pre-hospital and emergency department settings, in addition to experience in the operative arena. She enjoys precepting, mentoring, and developing programs for training centers to use as educational tools. Her passion for caring for others innately stems from multiple generations of nurses in her family. Mrs. Rose has been published in the Rapid Access Guide for Triage and Emergency Nurses, as both a contributing author and peer reviewer. Writing this blog during the coronavirus pandemic provided an outlet to release emotion and illuminate the world of critical care. Through her dedication to bedside care and writing, Mrs. Rose inspires fellow nurses to be a bigger part of the nursing community. You can connect with her at [email protected]
How to contribute
We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]