Critical Care Awareness Month: Meet Some ICU Professionals
May 5, 2022
It can be frightening when a family member or loved one needs care in an intensive care unit (ICU). Although most visitors to an ICU may only encounter nurses and doctors, many healthcare professionals work in these units. To help mark Critical Care Awareness Month, four ICU team members – a pharmacist, respiratory therapist, clinical nurse, and nurse manager – spoke with Sepsis Alliance to share how they spend their days helping critically ill patients and their loved ones.
Shereef Ali, PharmD, (Pharmacist)
It may surprise some ICU visitors to learn that pharmacists have an active and vital hands-on role in ICU care. According to an article published in the Journal of the Intensive Care Society, “Pharmacists intercept and resolve medication errors, optimise medication therapy and undertake broader professional activities within the job role that contribute to the smooth running of ICU.” In other words, they are the medication specialists on the team.
Shereef Ali’s day begins with checking on each patient and their progress. “Usually, I’ll spend a good part of an hour and a half, maybe two hours, working up all the individual patients in the unit,” he explained. This includes making sure the patients receive the proper medication therapies, whether antibiotics are appropriate or discontinued when not needed, checking on blood tests, etc. How long this takes depends on how much needs to be done for each patient. Interruptions, such as rapid responses (patients suddenly getting much sicker and needing emergency care) or code blues (cardiac arrests), can also keep him busy.
Dr. Ali then goes to the unit and does rounds with the ICU team. This team includes doctors, residents, interns, nurses, respiratory therapists, and any other professional needed for a particular patient. The team discusses the patients’ status, progress, treatments, and any outstanding problems. This can take a better part of three to four hours, he said.
Once rounds are complete, Dr. Ali’s tasks may include giving physician or nursing education sessions on medication topics, new guidelines, or therapies. He may work with students or consult with doctors about individual patients. Dr. Ali is also part of a team developing protocols, such as a sepsis protocol. “We have a sepsis group that meets a minimum of once or twice a month,” he said. “We’ll look at things like what are we missing? Are we getting our blood cultures done in a timely fashion? Are we getting antibiotics in a timely fashion as defined by the bundle?”
Megan Hennessy, RRT, ACCS, MBA (Respiratory Therapist)
Respiratory therapists, professionals with expertise in providing oxygen therapy, breathing treatments, mechanical ventilation, and more, also have an essential role in critical care. Megan Hennessy is the Divisional Director and oversees three departments at Jefferson Health – New Jersey, part of Jefferson Health. Ms. Hennessy has always worked in critical care. “I think I had the most interest in the critical patients and the difference that I could make with them,” she said. “I just felt more useful in those areas.”
She explained that a typical day for respiratory therapists in an ICU is very hands-on. After learning how their patients did during the previous shift during report (the process of one shift handing off to the next), they check on their them to evaluate their status and assess their needs. The therapists provide treatments and check machinery, like ventilators. When caring for sepsis patients in particular, changes in oxygen demand is one of the first things you look for, Ms. Hennessy said. This can help catch a patient before they deteriorate too quickly. Once the assessments and treatments are done, barring any emergencies that may pull them away, next comes rounds with the team.
Family education is also an important part of their day. The respiratory therapists teach visitors about the different treatments and the devices that help their loved ones breathe. This includes anything from masks to ventilators. Machines can seem frightening, but things often seem less stressful once the visitors understand what is going on.
Renee Stephens, BSN, RN, CCRN (Clinical Nurse) and Donna Cybulski, MSN, RN (Nurse Manager)
Nurses are the most frequently seen people in critical care because they are there 24/7, caring for their patients. Renee Stephens is an ICU clinical nurse at Jefferson Washington Township, working primarily in a neurological ICU. Ms. Stephens’ unit uses 12-hour shifts, which help limit shift changes. The longer shifts also allow the nurses see their patients’ progress over a more extended period.
Nurses in critical care have fewer patients to monitor and treat due to the higher workload. The nurses have to watch for any changes in their patients’ status, no matter how subtle. “Something could be off just a little bit on a lab, or something like that,” Donna Cybulski, a nurse manager at Jefferson Hospital Cherry Hill, explained. On a medical-surgical floor, nurses care for many patients. In an ICU, the nurses can concentrate on one or two, allowing them to see the changes earlier than someone busy with other patients. “The main goal of putting somebody in ICU is to make them not have any other complications, we kind of all are the stop date for that, because we’re watching them,” Ms. Cybulski said.
A nurse’s day begins much as it does for the other team members. It starts with report, meeting, and assessing the patients, and then participating in rounds. It’s not easy to describe a typical day for an ICU nurse because so much can change so fast with these very ill patients. “You plan your day according to the acuity of your patient,” Ms. Stephens said. Sometimes the patients may be improving to the point that they don’t need you there all the time. That’s when you go see if another nurse needs you as they try to stabilize their patients, she added.
Nurses also spend much time educating families and loved ones. “When a family member arrives for the first time in the room, my nurses always take them through kind of a tour of what’s around their loved one, and what that particular thing is doing for the loved one,” Ms. Cybulski said. “If we think that there is something that this family member is going to have to deal with at home, we do have them participate in care.” Family members can even be taught how to work with the ventilators, do wound care, and so much more to prepare for their loved one’s discharge.
Ms. Stephens pointed out that they also have to educate visitors about their surroundings. “We spend a lot of our time trying to calm down the families because they get excited at every little beep or buzzer. But we have the alarms set to help us. We spend time explaining to them that if they hear something, we already know what’s going on, and we explain how.”
Families and loved ones also can participate in rounds as the team discusses each patient. “The [physician in charge] will answer questions from the family or the patient if they can speak.” Patients who are in septic shock or who have severe sepsis are the sickest ones in the unit though, Ms. Stephens said. “They’re most likely on a ventilator, they’re most likely sedated.” The nurses have to work to get their blood pressure back up, keep the patients from fighting the ventilator, and watch for issues like renal failure because so many complications can occur so fast. “They’re really busy patients,” she said.
Families and loved ones in a critical care unit are living a nightmare. They don’t know if their loved ones will survive, and if they do, how their life will change. But Ms. Cybulski doesn’t want people to be fearful of the ICU. She thinks the fear is the first thing that drives people when they hear they’ve been moved to the ICU. “But it’s not a death sentence. It just means that they will get a little more intense care and observation that they need,” she said. “And I also think that they need to understand that we want them to participate and be at their family member’s side. We want them to be involved. My nurses love teaching. They love talking to the families, reassuring the family that it might sound like a scary place, but it’s not.”
Sepsis Alliance created two guides to help people learn more about sepsis and the ICU – one for adults and one for children. Download them and their companion guides here.