britta's AMA

[britta]

I'm an ICU nurse. My specialty is cardiothoracic surgery, so ask me about all things related to being a nurse, working in ICU, open heart surgery, lung surgery, heart and lung transplants, and anything else you have a burning desire to know!

[teachermomtobe]

What is the best and worst part of your job?

[mikaela20]

Do you watch TV hospital shows like Grey's, Code Black or Saving Hope or are you sick of the hospital scene when you get off work?

What are the biggest misconceptions of working in a hospital and how they portray it on TV shows?

[mikaela20]

Feb 16, 2016 8:29:33 GMT -5 W said:

Do you watch shows like Greys or Nurse Jackie? If so, what's the most common misconception from your job that the show portrays?

Get out of my brain! Lol

[onesweetworld]

Have you saved anyone's life? If so tell us the story you hero!

[mikaela20]

Losing patients- is it always emotional or do you get desensitized over time?

[onesweetworld]

In all of the TV shows, there is a lot of on call room sex...is this a real life thing too?

[britta]

Feb 16, 2016 8:16:41 GMT -5 teachermomtobe said:

What is the best and worst part of your job?

There are a lot of "bests", I think. My favorite part is being a part of the progress the patients make. When I work open heart recovery, it's pretty awesome to go from having a patient still asleep on the ventilator at the start of my shift to being able to have them stand and sit in a chair by the end. In ICU the progress is a little slower, but the wins are bigger. Being with a patient who had a huge esophageal surgery be able to drink for the first time in months or seeing a patient whose struggled in and out of the hospital with heart failure finally get the call that they're getting a heart, it's amazing to be a part of.

Worst? It's very exhausting. Mentally, emotionally, and physically. Patients in the ICU tend to be there for long periods of time and the care team is a lot more invested in them than I think most people think. We rejoice in their triumphs and hurt just as hard when we don't have the best outcome. My mind is always on at work-there's rarely downtime. The last shift I worked I went close to 10 hours without peeing. And that's kind of the norm.

[onesweetworld]

Have you ever gone against a doctor's wishes to save a patient?

[britta]

Feb 16, 2016 8:29:33 GMT -5 W said:

Do you watch shows like Greys or Nurse Jackie? If so, what's the most common misconception from your job that the show portrays?

I watched House when it was on. I've seen most of the medical dramas and found that it most medically accurate. Aside from the doctors giving meds and drawing blood. My favorite medical mistake is when a patient is "coding" and the medical team shocks a patient who is flat lined. That doesn't happen. Also, the annoying beeping the monitors make...where they beeping gets slower and then is one constant beep when the patient flat lines? Yeah. It's not like that.

[britta]

Feb 16, 2016 8:31:19 GMT -5 W said:

Also, without going into detail, have you ever seen something done that wasn't ethical or was downright illegal?

Ethics is so hard. Yes, I've seen things that I considered to be unethical. Illegal? Yes to that too. Narcotic diversion is big among healthcare workers. It's sad.

[britta]

Feb 16, 2016 8:31:19 GMT -5 mikaela20 said:

Do you watch TV hospital shows like Grey's, Code Black or Saving Hope or are you sick of the hospital scene when you get off work?

What are the biggest misconceptions of working in a hospital and how they portray it on TV shows?

I feel like one of the biggest misconceptions is how much downtime there is for the staff. LOL. Maybe it's like that out on the floors but we don't stand around and chat much in ICU.

[britta]

Feb 16, 2016 8:33:09 GMT -5 onesweetworld said:

Have you saved anyone's life? If so tell us the story you hero!

I mean, I used to be a part of the code team, so anytime someone had a respiratory or cardiac arrest somewhere in the hospital I would go. I've done CPR so many times in one night that I was legit sore the next day. I was 17 the first time I did chest compressions in a code.

Outside of the hospital, I haven't had to use my life-saving skills. Thank the Lord.

[britta]

Feb 16, 2016 8:33:58 GMT -5 mikaela20 said:

Losing patients- is it always emotional or do you get desensitized over time?

I think you learn how to let it go easier over time, you don't dwell on it as much and let it affect how you have to care for your other patient (if you have one at the time), if that makes any sense. I will say, the older I've gotten and longer I've been in the game, the more comfortable I am grieving with the patient and family. I used to think I had to keep it together for them and then breakdown in my car but I think it's nice for the family to see that it matters to their care team.

[britta]

Feb 16, 2016 8:35:45 GMT -5 W said:

Is there legit animosity between nurses and doctors that you often see in TV shows? Because TV shows portray that nurses do twice the work for less than half the money and they are often dissatisfied with the doctors

I think so, but I also think it's come light years away from what it was. They used to teach nurses in school to give up their chairs when the doctors came on the floor and to fetch their coffee. It's not like that anymore. I also think the power differences between doctors and nurses depend greatly on where you work and how long you've been working. I find in ICU the docs are much more receptive to what the nurse has to say because we are expected to have a certain level of knowledge and education and have a lot of autonomy compared to nurses who work in med-surg. Also, regardless of where you work, the more a doc works with you and begins to trust you, the better the relationship. I also think new docs are being taught that all members of the care team have a different perspective and potentially something helpful to bring to the table. It's definitely getting better but in a lot of ways we have a long way to go.

[britta]

Feb 16, 2016 8:37:55 GMT -5 onesweetworld said:

In all of the TV shows, there is a lot of on call room sex...is this a real life thing too?

Haha. I think there's more hanky panky among nurses than between nurses and docs than most people think.

FWIW, my husband is a PA and, despite working together for 7 years now, there has never been any call room sex. First, ain't nobody got time for that and second, ew. Hospitals are gross. DNW MRSA and C.diff any closer to my body than what it already is.

[britta]

Feb 16, 2016 8:38:56 GMT -5 onesweetworld said:

Have you ever gone against a doctor's wishes to save a patient?

Hmmm...I'll have to think on this one. I want to say no because anytime (that comes to mind) where I felt the orders I received or the care we were giving maybe wasn't the best choice I've been able to voice that concern either with the doc themselves or through the appropriate chain of command.

[butlerfan]

Thank god for nurses!!!! I was in NICU when I was a baby for 9 weeks. So thank you for doing what you do.

[onesweetworld]

Feb 16, 2016 8:56:48 GMT -5 britta said:

Feb 16, 2016 8:37:55 GMT -5 onesweetworld said:

In all of the TV shows, there is a lot of on call room sex...is this a real life thing too?

Haha. I think there's more hanky panky among nurses than between nurses and docs than most people think.

FWIW, my husband is a PA and, despite working together for 7 years now, there has never been any call room sex. First, ain't nobody got time for that and second, ew. Hospitals are gross. DNW MRSA and C.diff any closer to my body than what it already is.

Did you meet YH at work?

[onesweetworld]

Give us an idea of what a normal day is like....

[britta]

Feb 16, 2016 10:43:19 GMT -5 onesweetworld said:

Feb 16, 2016 8:56:48 GMT -5 britta said:

Haha. I think there's more hanky panky among nurses than between nurses and docs than most people think.

FWIW, my husband is a PA and, despite working together for 7 years now, there has never been any call room sex. First, ain't nobody got time for that and second, ew. Hospitals are gross. DNW MRSA and C.diff any closer to my body than what it already is.

Did you meet YH at work?

Yes. I had been working as a nurse in ICU for almost a year when he took a position with the heart surgeons straight out of PA school. We hung out with the same people outside of work. The rest is history.

[britta]

Feb 16, 2016 10:43:50 GMT -5 onesweetworld said:

Give us an idea of what a normal day is like....

So I currently work the majority of my time in the open heart recovery unit on nights (11p-7:30a usually, sometimes 7p-7:30a).

I come in and get report from the off going nurse. We do bedside report, so after the nurse tells me the story and the need-to-knows, I double check all the drips (continuous IV meds), ventilator settings (if applicable), surgical dressings, chest tube and urine output before she goes.
Assuming there are no pressing issues, I go back to the desk and read through the operative note and make a mental note of things like pre-op ejection fraction (matters to me because this number will dictate if and how soon I'll adjust my IV med), fluids/blood products given in OR, whether they received steroids or not, and if there was any intra-op issues like low blood pressure or an extended cardiopulmonary bypass run. I print off a baseline EKG strip.
Then back to the patient's room to do a full head to toe assessment and give any meds due. Usually, if they've been out of OR awhile, I get them out of bed and have them stand to get a post-op weight to assess fluid status. If they're just getting out of OR I'm monitoring blood work and assessing bleeding/vital signs to decide when we can "wake" the patient and remove the breathing tube.
The rest of the night consists of checking urine and chest tube output and blood sugars hourly or every half hour. Vitals signs are visible on the monitor continuously (blood pressure via an arterial line, internal heart pressures, O2 level, heart rate/rhythm, respirations, and temp) and I make IV med adjustments, give or take off fluids, change O2 concentration, etc based on the numbers. Head to toe assessments are done every 2 hours. Lab work and a bedside chest X-ray are done at 3AM usually. I work with the patient on some breathing exercises periodically to open their lungs and prevent pneumonia. Give pain meds, like, hourly.
The last two hours of my shift are usually getting the patient into a chair and removing all of their invasive lines to get them ready to go to the regular medical floor. If they're unstable, I transport them to ICU.
That's prob way more than you needed to know, but the most basic of routine I can tell ya. Of course, it all depends on the patient and how stable they are after surgery.

[♪♫choppinbroccoli♫♪]

Any "no way!" stories of patients doing crazy things?

ETA: I can see that being in ICU, you might not get a lot of intentional stressful activity, but do you have any stories of times where something happened and you could hardly believe it?

[britta]

Feb 16, 2016 11:05:42 GMT -5 ♪♫choppinbroccoli♫♪ said:

Any "no way!" stories of patients doing crazy things?

ETA: I can see that being in ICU, you might not get a lot of intentional stressful activity, but do you have any stories of times where something happened and you could hardly believe it?

I've walked in on a patient whose girlfriend was giving him a BJ, literally 15 minutes after having his catheter removed. Gross.

There's a lot that I've seen that I still have trouble wrapping my head around. Like the kid that was found down in a snowbank for an unknown amount of time. EMS and the ER did CPR for 3 hours to get the patient to us. We put the the patient on ECMO and the patient eventually walked out of the hospital completely fine.

I've had a patient who had an external heart pump on both sides of her heart. On the monitor she was flat lined. The pump was providing all of her heart motion and circulation, there was no electrical activity. But she was up in the chair eating breakfast. Wut. So weird.

Is that kind of what you were asking?

[♪♫choppinbroccoli♫♪]

Feb 16, 2016 11:12:21 GMT -5 britta said:

Feb 16, 2016 11:05:42 GMT -5 ♪♫choppinbroccoli♫♪ said:

Any "no way!" stories of patients doing crazy things?

ETA: I can see that being in ICU, you might not get a lot of intentional stressful activity, but do you have any stories of times where something happened and you could hardly believe it?

I've walked in on a patient whose girlfriend was giving him a BJ, literally 15 minutes after having his catheter removed. Gross.

There's a lot that I've seen that I still have trouble wrapping my head around. Like the kid that was found down in a snowbank for an unknown amount of time. EMS and the ER did CPR for 3 hours to get the patient to us. We put the the patient on ECMO and the patient eventually walked out of the hospital completely fine.

I've had a patient who had an external heart pump on both sides of her heart. On the monitor she was flat lined. The pump was providing all of her heart motion and circulation, there was no electrical activity. But she was up in the chair eating breakfast. Wut. So weird.

Is that kind of what you were asking?

Yes, exactly. I liked all three of those stories.


So, what I took from that first story is that there is hanky-panky, but not necessarily from employees. LOL.

[britta]

Other crazy ish...

Sometimes, things go terribly wrong in the OR or the patient has an incredibly complicated surgery. When that happens, often the patient will have received a lot of fluid or blood products and, at the end of the case, their chest can't be wired back shut because of all the swelling. So the surgeons put basically a big transparent sterile dressing over the chest. It's crazy to stand next to the bed and be like "Oh look. There's the patient's heart just beating away under there."

I've assisted the surgeon and/or PA having to re-open a patient's chest in recovery or in the ICU. Not a fun experience.

[JustJudy]

Omg yuck to the BJ story!

How long do you think you'll work in ICU? Do you see yourself there long term or do you hope to move to another specialty at some point? And, is that even a thing in the nursing world?

[britta]

Feb 16, 2016 11:21:47 GMT -5 JustJudy said:

Omg yuck to the BJ story!

How long do you think you'll work in ICU? Do you see yourself there long term or do you hope to move to another specialty at some point? And, is that even a thing in the nursing world?

It is a thing, yes! There's so much to do in nursing. I know there's quite a few other ladies here who work in other specialties, like oncology.

AFM, ICU will probably always be my passion. I did a stint 3 years ago as a nurse manager in a rehab facility/nursing home. I had been doing ICU for about 6ish years and was kind of burnt out, so I thought I'd try something different. It just wasn't my thing. I did work as the ICU supervisor for a short period as well. I liked that and could see myself doing it again someday, but right now I'm happy to be back in direct patient care. Teaching sparks my interest too.

[teachermomtobe]

Do you get lots of family or friends asking you for medical advice or to "take a look at this" since you're a nurse?

[britta]

Feb 16, 2016 11:31:41 GMT -5 teachermomtobe said:

Do you get lots of family or friends asking you for medical advice or to "take a look at this" since you're a nurse?

LOL, yes all the time. I feel like I have a decently broad knowledge base so *sometimes* I can help. When things get really specialized though, I can't help you. A "does this look infected?" will get a "yes". A "ok, with what?" will probably get a blank stare and shrug.

Also, other providers will expect you know everything. For example, my OB and our pediatrician. When I was pregnant with DS, I literally had to look at my OB in our first appt (who knows what MH and I both do) and say, "Look, unless my cervix has had or will be having open heart surgery, I have no idea what you're talking about. Please to dumb down." He laughs at me.