First float as a critical care nurse

fear vs courageI feel that anytime you float to another unit, there’s some anxiety because you’ll call different providers, things are in different places and there’s usually a different patient population. Since I came off of probation, I have to float now.

My first float was at the SICU. While there, I had 2 medical patients, so at least I was used to that. Here are a couple of things there made me feel comfortable.

  1. A list of numbers for the MLPs (the critical care PA, vascular PA, and surgical PA), respiratory therapist, med cart code, nurses lounge. If the float unit is nice, then they will already have these on a sheet prepared for you. If not, then ask the charge nurse or the secretary for this information.
  2. Bringing my own SBAR form. The float unit may not have the same form as your home unit.
  3. A quick orientation of the unit. Having an idea of where everything is will give you the tools you need to succeed!
  4. Remembering names. Introducing yourself to the nurses next to you and to the axillary staff and remembering their names will make it much easier to get help (or help them!) and get the job done.
  5. Ask questions. As always, feel comfortable asking questions! Anything from, ‘Where can I find a 3cc syringe?’ to a patient’s deteriorating condition to ‘can I have a boost?’

Although I had a pretty good first float, I’ve heard other stories from my coworkers stating that they had too many patients. You should be able to get the same ratio of patient population as you would normally. Good luck on your first float! 🙂

My First ICU patient who passed away

He officially passed away this morning
while I was on break. DNR status.

Yesterday his son asked for my thoughts.
“I think he’ll make it tonight.”
Even though he was slowly deteriorating,
Maxed out on oxygen and 3 drips to keep up his blood pressure.
On fentanyl to make him comfortable.
He made it.

I returned last night.
It was a different story.

“Jessica, how’s he doing?” His son asked.
The generic “he’s fine” is off limits. It was time for the truth.

“Last night his respiratory rate was 9 or 10. Now it’s 15-18.
Often when people are nearing the end of life,
it goes from slow to faster and back to slow again.”

“But his heart rate looks ok. It’s 85.”

“Yes that’s true.
But his blood pressure is slowing decreasing.
His heart is still trying to compensate.”
He cocked his head. I tried again.
“His heart is trying to get enough blood to his body
but it’s not working. It will eventually give up.”

Optimism in his voice,
“But wouldn’t the heart rate slowly taper off?
I thought he would live a couple more days.”

“No, his heart can suddenly stop because it’s giving up.
I’m not sure if he will make it through the morning.
His drips cause his blood vessels to constrict.
That explains why his hands are cold
and the oxygen probe to not read well.”

After midnight, his HR was suddenly dropped to 42. RR was 9. SpO2 77%.
“Can you give us an update, doc?”

“Well I’m not a doctor.”

“It’s ok. We’ve promoted you. Just give it to us straight.”

I started to tear up a little bit.
It wasn’t easy for me to tell them what I thought:
He’s on his way out.

They told me that they’ve shed their tears already
and were waiting this.
“Thank you for taking great care of him.
You should be proud of you and your coworkers.
Tremendous sense of purpose and goal and comradery.”

His blood pressures stop reading.
Apnea alarm sounds.
That probably should’ve been my cue.
I still felt a carotid pulse.
I checked my drips.
Gave report and went on break.

I came back from break and looked at the monitor.
His was black.
“Your patient expired.”
Icy cold hospital terminology.

I debriefed with the experienced nurse covering for me.
What could I do better next time?
1. Listen for his heartbeat, not only feel for pulse.
2. Consider the BiPAP machine delivering breaths for him.
What’s the rate set at and what is his RR now?

In the final progress note
Include: heart rhythm- PEA,
who pronounced time of death,
which doctors notified of death.
Family at bedside or contacted.

In the end,
This family was ready to accept their father’s fate.
The son shared his friend’s voicemail message:
“How did they prepare the chicken?
They told him he was going to die.”
We chuckled.
Humor can start the healing process.

After I gave report,
I said bye to the family
And they all gave me a hug
And thanked me again.

I drove home
Half crying
Trying to drown the feeling
By turning up the radio.

I showered, ate, and wrote this down
So that I don’t forget.