The challenging environment of an intensive care unit nurse

Translation: Victoria Bakshina

Since the pandemic hit, intensive care unit nurses and the importance of their job have become more noticeable in the social dialogue of Icelanders. These people whom we call heroes and front-line workers, have stood at their posts through the COVID-19 with outstanding diligence and dealt with serious consequences of this pandemic with determination and professionalism. The Student Paper spoke with three nurses in the intensive care unit of the National Hospital at Hringbraut to learn about the unique working environment and what makes intensive care unit nursing different from other specialities.

THE NATURE OF INTENSIVE CARE NURSING

Regina Böðvarsdóttir has a master's degree in intensive care nursing and 20 years of experience at the intensive care unit at Hringbraut. She describes the job as dynamic and professionally challenging.

“In the intensive care unit (ICU), we take care of all age groups from three-month-old children up to centenarians. Extremely ill individuals from other units are sent to us, along with individuals who have undergone major surgeries and will need more monitoring. In other departments one nurse often tends to many patients, but in the intensive care unit each of us are with only one patient throughout our shift.”

Patients in the ICU require continuous monitoring and more treatment than patients in other departments, and their condition can change rapidly. The job of an ICU nurse is to monitor the condition of these individuals, predict adverse events before they happen, and provide preventive treatment that requires a lot of clinical knowledge.

“Iceland is a small country and is not very specialized, so we accept all possibilities and I'm always learning something new, which is a great experience. This can be a very rewarding job, but often it can be very difficult. But the colleagues are always there for you - it is always possible to search in the near infinite fountain of wisdom of others. I think it's great to be professional in dealing with a dynamic environment [that the ICU is], it causes me to never get bored at work. You never know what can be expected of you when you attend, and there is always an opportunity to improve one’s knowledge.”

A JOB THAT IS BOTH REWARDING AND CHALLENGING

Anna Halla Birgisdóttir has a master's degree in intensive care nursing and 7 years of experience at the intensive care unit at Hringbraut. Additionally, she has worked in  another inpatient unit of the National Hospital and a hospital in the countryside.

“What fascinates me about the ICU is the ability to concentrate entirely on a single patient and their family, to give one person everything that I have. It may sound easier, to be with one patient instead of many, but this person is extremely challenging and very sick – you need to have your eyes on them the entire shift. “

Anna Halla says it is informative to place oneself into treatments that are often very complex, where one must deal with many specialities of medicine and take part in a concerted team effort by health professionals regardless of one’s occupation. To a certain extent, she says this gives a greater perspective for nursing and a holistic vision of the patient.

“Many bodily systems of the patient can be out of order, and one is in fact conducting a treatment when other multiple treatments are taking place simultaneously - the job of an ICU nurse involves evaluation and prioritization, assessing what’s most important now and what could wait.”

When asked what is most challenging about the job, Anna Halla says that it is often difficult to deal with situations where people feel really bad.

“We accept the sickest people, and it is challenging to respond to and meet the distress and suffering that patients and families are experiencing. As hard as this job can be, it is still so rewarding, especially when the former patients come for a visit at the unit. It is uniquely satisfying to see them return to life and feel gratitude from them and their families.”

AUTONOMY AT WORK

Eyrún Catherine Franzdóttir is a nurse with 7 years of experience at the intensive care unit at Hringbraut, first as a student nurse, and now as a registered nurse working alongside her master studies in intensive care nursing at the University of Iceland. She describes intensive care nursing as unique in the sense that it is more holistic than many other specialities of nursing.

“We need to know how to operate the life support machine, and all kinds of complex devices to provide appropriate treatment. Nurses in the ICU control a lot of things and I feel a lot of trust from the staff around me. My idea of a treatment may be just as good as the idea of a specialist physician or a nurse with more experience.”

Intensive care nursing is therefore multifaceted and involves technical skills, prioritization, and great communication skills needed when it comes to communicating with patients and family members in special and often difficult situations.

INTENSIVE CARE NURSING IN TIMES OF PANDEMIC

The increased pressure on the health system in the era of the COVID-19 pandemic has been discussed ad nauseum. The staff of the intensive care unit are in one of those occupations which are called front-line workers, who provide treatment in severe cases of coronavirus. Eyrún says the strain at the department has changed in the era of the epidemic.

“I started working as a nurse a year and a half before COVID-19 and noticed that the job had more highs and lows, or certain stressful periods before the pandemic hit. The pressure during COVID-19 has been heavier for longer periods of time, people are sick for longer and get released from the intensive care unit later. We feel it a bit, as the nurses, we are tired because of the prolonged strain.“

When asked whether she thinks that authorities have done enough to pay the ICU staff for the increased load at work, Eyrún says that a lot of things may be improved.

“I feel that an acceptable salary for nurses in general is the most relevant. I do not need a special incentive or surcharge payment to do my job if it is worth it to begin with. We have all been running faster and putting more on our shoulders during the pandemic in order to keep things going. It should be rewarded by meeting our wage demands and paying us in accordance with the workload that accompanies this job, regardless of whether there is a pandemic or not.”

Therefore, it is clear that the good work that is being done in intensive care units could still be improved by increased staffing to reduce the workload and raised wages in accordance with the nature of the job and the responsibility that accompanies it. One may mention that in the intensive care unit at Hringbraut there are 10-11 spaces available to patients, but as today there are only 7 of them open because of the labor shortage and lack of resources.

It stands to reason that politicians should do much better in terms of handling the wage affairs of nurses and the budget for the health care system in general. Despite that, and despite the increased load in these times of COVID-19, all three ICU nurses agree that they want to be here and nowhere else. What characterizes the intensive care unit at Hringbraut and makes the job unique and exciting, according to them, are the demanding situations, frictionless team work, steady growth in employment and a strong consensus of the staff in the constantly dynamic environment.