What Do ICU Nurses Do?

Deborah Chiaravalloti - 03/12/19

ICU nurses care for the most fragile, critically ill patients. They are described by leaders in the nursing profession as meticulous, organized planners who love detailed levels of care, and who can simultaneously “orchestrate 10 pumps, 6 drips, 4 beeps, and 1 crashing patient without blinking an eye”. It can be a pressure cooker of critical care that demands split second, life-or-death clinical decisions. If that sounds like the type of work you are looking for, read on.

To find a definition of exactly what an ICU nurse does, we went to the inside experts at Nurse.org. They describe the responsibilities of an ICU nurse as follows:

“ICU nurses treat patients who require the highest acuity of care in a very structured and controlled setting. In order to treat the most critical patients in the most thorough manner, critical care nurses use their specialized skills and extensive knowledge of disease pathology to provide interventions that sustain life."

“ICU nurses work quickly, efficiently, independently, and meticulously. They care for the most fragile of patients who hang on to life by a thread. Most patients in the ICU are intubated, ventilated, and on life-sustaining medication drips at the very least. Nurses need to be able to preemptively recognize signs of decompensation and act swiftly on them. They are advocates for their patients and work closely with the intensive care team to treat their patients. The environment is structured, high acuity, and multifaceted.”

ICU nurses describe the role in much the same way. A nurse posting on allnurses.com described the job as follows:  “ICU nurses typically care for patients who have had major invasive surgery, accident and trauma patients, or patients with multiple organ failure. They tend to be medically unstable, requiring constant cardiac and respiratory monitoring and continual adjustment of treatments, such as the titration and dosing of multiple intravenous medications and changes in ventilatory support. You are also confronted with end-of-life issues and ethical dilemmas.” 

As you would imagine, it takes a special personality to be an ICU nurse. Nurse.org described these personality characteristics in detail. ICU nurses thrive on (and we quote):

An organized workflow: An intensive care unit typically operates like a well-oiled machine and ICU nurses wouldn’t have it any other way. ICU nurses appreciate shifts that are structured, organized, and allow them to perform their work without hiccups.

Working in organized chaos: ICU nurses are meticulously organized. They have checklists of exactly which medications are due and highlighted grids of which are compatible together, which drips to titrate and when exact intake and output of fluids to the milliliters of blood are taken for lab draws, etc. It’s hard to catch an ICU nurse off-guard with a question about their patients’ care.

Helping patients return to long term wellness: ICU nurses have to look at every system in the body as interconnected and treat it as such; something that affects your neurological functioning may also affect your GI system, liver, kidneys, etc. ICU nurses often watch patients progress from critical illness to health again. The goal is long-term wellness; ICU nurses are very involved with patients and families, building rapport and providing education.

To understand what a day in the ICU can be like, it’s best to hear it directly from ICU nurses themselves. Here’s how one nurse described what any given day at work can be like. It’s far from routine:

“It’s entirely possible to have the same assignment two nights in a row and have two very different nights at work. You might assess, give the meds, bathe and turn your patient the first night. Everything goes smoothly, you have four to five hours of free time and leave on time at the end of your shift.

“The next night the patient’s vitals can be completely unstable, there may be a trip or two to CT scan, the other patient gets loose from a restraint and rips out his arterial line, you’re rapidly infusing blood products or fluid, a graft pops on a fresh heart causing the patient to tamponade (a build-up of fluid in the sac around the heart which compresses the heart) so the surgeon comes to the bedside and opens up the chest in the room while the other patient’s sister has called the unit for the eighth time that shift asking ‘How is he doing?’ and you have to try not to yell and instead say calmly, ‘nothing has changed in the last 45 minutes’. Then, you have to stay for an extra hour or two to finish charting and your own family is calling asking ‘When will you be done, we had plans tonight?!’”

That is the reality of being an ICU nurse. The job can also be enormously gratifying, providing a front row seat as a member of a team with the skill to save lives and bring a patient back from the brink of death. One particularly moving narrative about this is posted on icufaqs.org. Written by an ICU nurse, the story relates the journey caring for a man who was near death for two months. After receiving meticulous care from ICU nurses, hundreds of blood products, medications and interventions, he woke up, and was well enough to be transferred to a general med/surg floor. Reading this short piece is time well spent.docAs the nurse writing the piece so illustratively said:

“If the particular expertise of each (clinical) service could be thought of as a ray of light shone upon the patient from a separate angle, trying to illuminate some aspect of his condition, then the ICU nurse should be thought of as the focusing lens through which those rays have to pass. It is, after all, through the hands of the nurses that all this information flows, and through which the medicines are given - through their eyes that the effects are noted from minute to minute, through their continuity of presence that the promise of careful watch is kept.”

Being an ICU nurse is the only place to be if you thrive on fast paced, split second decision making and the delivering the most critical care a patient can need. As one ICU nurse said; “What does an ICU nurse do? EVERYTHING! You keep your patient alive if that’s the plan, you give them a dignified death if that’s the way it goes, you take care of their families and you take care of each other and at the end of the day you walk out holding your head held high.”

To that we say, “Thank you!”