New Grad Radio: Intensive Care & Emergency Nurse
By New Grad Radio
Season 2: Find out what it's really like to work in the Emergency Department (ED).
Season 3: Foundations of Intensive Care Nursing for those 'up-skilling' to enter intensive care during the COVID pandemic.
New Grad Radio: Intensive Care & Emergency NurseApr 13, 2018
Physiotherapists in ICU with Samantha Hagan
On today's episode, I speak with Samantha Hagan. Sam was one of the first physio's I worked with as I started as a new grad nurse within ICU. Over those first few months I learnt an incredible amount from Sam. From the specific recruitment manoeuvres; to detailed chest auscultation; Chest X-Ray interpretation; and overall, the role of the physio within ICU.
Sam does a great job in outlining the role of the physiotherapist within ICU; details the rationale of specific manoeuvres including Manual Hyperinflation, and Vibes; details the equipment used; and outlines strategies for how Nurses and Physio's can best work together.
Troubleshooting the Ventilator + Alarms
Now that we've gone over the Modes & Settings, let's start talking about some of the most common alarms, what they mean, and what we could do about them as registered nurses.
There is one alarm in particular, Peak Pressure (High Airway Pressures), that has the potential to lead to an airway emergency. I outline a systematic approach to assess the situation; how to escalate, and how to overcome.
The key messages are:
- If you're ever unsure: Ask
- If the ventilator continues to peak pressuring, the patient is not ventilating during that time
- If in doubt, call for back up, and hand bag the patient using the Bag Valve Mask attached to Oxygen 15L/min.
Mechanical Ventilation - Modes (Pressure Support Ventilation)
This is where Pressure Support Ventilation (PSV), another type of mode, comes into it.
In today's episode, I detail the setting of Pressure Support; and mention at what stage we may switch the patient from a 'Rate' (ie SIMV) to PSV; and highlight a few key things for nurses to keep an eye on when doing so.
Mechanical Ventilation - Modes (AC vs SIMV)
Welcome back to another episode of the New Grad Radio podcast!
Let's continue on with another episode on Mechanical Ventilation.
As I mention in the episode, there are two broad concepts when considering modes - do we have full control and not wanting the patient to breath for themselves; or is that the intention, to allow the patient to take spontaneous breaths, and even take all breaths for themselves?
Today's episode describes the modes used for patients who are not breathing for themselves; whilst the next episode features modes when the goal IS for the patient to take their own breaths.
Mechanical Ventilation - Settings (Foundation)
If you've had a look at the ventilator in action, you'll notice there are numbers that remain fixed, and that there are numbers that seem to change from breath to breath. This is because there are particular settings that we mandatorily 'set' for the ventilator to deliver to the patient; whilst then we monitor the section to see what the actual patient is doing/receiving.
As mentioned I cover the majority of the absolute basics; yet there are some things I haven't covered yet. This will change in the coming episodes.
Today we cover:
- Tidal Volume (Vt)
- Respiratory Rate (RR)
- Positive End Expiratory Pressure (PEEP)
- Fraction of Inspired Oxygen (Fi02)
- Minute Ventilation (MV)
- Peak Inspiratory Pressure (PIP)
Mechanical Ventilation - The Ventilator
Welcome back to another episode of the New Grad Radio podcast.
This episode serves as the first of many to come, highlighting the foundational concepts of Mechanical Ventilation.
As I mention, I am not an expert. But I know what it's like to have started as a grad two years ago, having never seen a ventilator, nor a patient requiring mechanical ventilation. Over the last few years, I've worked in an ICU that has one of the highest percentage of patients requiring mechanical ventilation in Australia - meaning most days I turned up to work, I was directly caring for patients on a ventilator.
I remember what it was like to first stand in front of the ventilator, feeling a little overwhelmed, and learning absolutely everything from scratch.
I remember the questions I had when I first started. It was only a few years ago. And I'll keep those at the forefront of my mind as I create the proceeding episodes.
I'll attempt to keep each episode short, compact, and to the point. If you already have a decent foundation, please feel free to skip to the episodes you're interested in. For those who have never even seen a ventilator, i'll talk through everything I can, step-by-step; commencing with this episode, being the actual machinery of the ventilator; the components; and I highlight specific brands that I have personally worked with, to highlight that ventilators can come in all different shapes and sizes, and be used in different settings.
I don't profess to be an expert on this. I'd just love to pass along some of the knowledge and skills I've developed over the last few years; teach it at a foundational level, for those nurses who may be expected to be using this equipment for the first time in the weeks to come.
I'd love if you could keep me updated on what you think. Need more detail, going too fast, need more clarification, don't hesitate to send a message through to the New Grad Radio Podcast Facebook page.
Blood Gas Interpretation
Welcome back to Part 2 on a two-part segment on Blood Gases. In this episode I highlight a basic, systematic approach to analysing a blood gas, including a discussion on ‘normal’ values, a process of contacting the doctors, and speak on some nursing interventions.
As I mention in the episode, this is a topic you could cover for HOURS, but I really want to provide the absolute staples, so if you have never used a blood gases, it could give you at least a foundation.
Resources:
- Blood Gas interpretation game (HIGHLY recommend) - https://abg.ninja/abg
- Roger from Med Cram does a great job on explaining the basics. This is episode 1. It's a multi-part series found on YouTube that starts light, and ends up going DEEPER each episode. Not a bad start with this one: https://www.youtube.com/watch?v=4wMEMhvrQxE
- This is a nice step-by-step guide to ABG analysis by the American Thoracic Society. Have a look towards the end of the page, as it lists conditions associated with the analysis. It goes one step further than most fundamental lessons, giving the 'so what': https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/abgs.php
Fundamentals of Blood Gases
On today's episodes, I describe:
- What is a Blood Gas
- How to collect a Blood Gas
- How to Run a Blood Gas
- Differences between Venous and Arterial samples
- What information does a Blood Gas provide.
I hope you enjoy. If you have any questions, don't hesitate to send a message through.
Central Lines
In this episode, I break down the absolute basics of central lines. In particular I mentioned the features; talk over the purpose of the 'lumens'; and speak of some particular nursing considerations.
Arterial Lines
Within the episode, I will break down:
- What is an arterial line
- The purpose of the arterial line
- Components
- Nursing Considerations
- Troubleshooting
Here are a few resources that you might find useful:
- A NSW Training Package on a few of the concepts I discussed: www.aci.health.nsw.gov.au/__data/assets/pdf_file/0012/221214/haemodynamic_monitoring_LP_2008.pdf
- For those of you who REALLY like to know the WHY, Deranged Physiology has you covered:
derangedphysiology.com/main/cicm-primary-exam/required-reading/cardiovascular-system/Chapter%20760/normal-arterial-line-waveforms
As always, if you have any questions or comments, please don't hesitate to send me a message on the New Grad Radio Podcast FB page.
Welcome to Season 3
I am proud to be an intensive care nurse. I absolutely loved starting my career within this setting. However I can only imagine the apprehension of the clinicians who are currently being rapidly 'up-skilled', in order to provide assistance to intensive care unit's across Australia, as we brace during this time period of the COVID-19 pandemic.
Over the period of a year, I was fortunate to have been eased, and guided into what was my new role as a graduate nurse in ICU. I was provided the opportunity to learn, grow, hone my skills, and develop in a controlled way.
I can only imagine what it would be like for the nurses, from a variety of clinical backgrounds, to absorb as much as possible, in order to feel 'safe' to work in what can be an intense, and highly stressful work environment.
THIS is the purpose of Season 3 of the New Grad Radio podcast.
I do not profess whatsoever to be an 'expert' in ICU. Two years is not a lot of time. There is SO much more to experience and learn to get to that stage. However for the purpose of 'starting' in ICU, and the challenges that come from starting in ICU, I know those feelings intimately.
Over the course of Season 3, I hope to develop content that is relevant for these nurses about to step into this new role.
I will speak of concepts that I feel confident and competent to talk about....and for more advanced concepts....I will be interviewing guests with far more exposure and experience.
So welcome back to the New Grad Radio podcast. If you, or someone you know would like to request topics, please send through to the New Grad Radio Podcast facebook page.
Final Episode
Welcome to the FINAL episode of the New Grad Radio podcast.
It has been an absolute privilege to document my journey with you all over the past two years. Thank you so very much for following my progress. You have experienced the nerves of starting; hearing what I struggled with, what I found exciting, difficult, and new. Each step of the way, you see what I was thinking at the time. I truly hope I was able to capture the essence of what was my graduate experience.
I wanted the emphasis to really be on 'documenting'. To not only provide the new and exciting; but also of the things that are realistic about starting at a registered nurse. As you have heard, being a nurse is not always easy. But I wouldn't have traded my experiences for anything!
In this final episode, I talk about my final week; the opportunities that are available in both ICU and ED that I haven't experienced yet; and I make a BIG announcement of what i'm up to next.
(Spoiler alert; you'll be able to follow my progress next year on another podcast...listen for more details).
Thank you again for listening. This has been Ben Jenkins with, the New Grad Radio Podcast.
Final Shift in ICU
Royal Flying Doctor Service - Special Guest: Nick Coleman-Hicks - Flight Nurse
There is one area of nursing that I believe a lot of people have thought of at one time or another; I know I certainly have; that can offer excitement, travel, autonomy, challenge and diversity, career progression, you name it, this job has it.
On today’s episode, I'll be interviewing Nick Coleman-Hicks, who currently works as a Flight Nurse, with the Royal Flying Doctor Service.
Hailing from Sydney, Nick has worked within areas such as Intensive Care, and Emergency, and has completed a variety of post graduate qualifications including a Graduate Certificate in Critical Care Nursing; and a Graduate Diploma of Midwifery, and has gained some relevant experience practicing as a midwife, which is a vital skill to work with the RFDS.
Today, Nick elaborates on how he got into nursing; his incredible career thus far; his experiences as a student midwife; the benefits of working in both ICU and ED; and goes into detail of what his job entails as a Flight Nurse with the RFDS.
An Interview with a Doctor - Special Guest: Lewis Robinson (SHO)
A particular area, that I struggled with, and I find a lot of graduate nurses struggle with, is understanding how to work with doctors. Now what I mean by that, is that it can often be an intimidating experience, of understanding how to present information to medical staff; knowing what doctor to relay information onto; understanding at what stage they would like to be notified; and exactly what they would like to be notified about. Even the simple act of picking up the phone, and speaking with the doctor is a lot harder than you’d think. So, that’s the purpose of today’s episode. Today, I'll be interviewing Lewis Robinson.
Lewis Robinson studied a Bachelor of Medicine, Bachelor of Surgery at the University of Queensland, and is currently working as a Senior House Officer (SHO) within the Emergency Department, and has now started a rotation within the Intensive Care Unit.
I’ve worked besides Lewis for the past year now, and I've seen first hand just how motivated, caring, and switched on he is as a doctor. And a big reason i’ve asked Lewis to share his experiences on the podcast, is how approachable he is, and how well he works with nursing staff, and the entire interprofessional team.
In today's episode, we cover:
- What motivated Lewis to become a doctor
- Lewis's journey through medical school, including the types of placements all medical students must complete
- Lewis's Intern Year; with an explanation of the different 'levels', or the 'hierarchy' of doctors throughout Australia
- The expectations placed upon said levels of doctors
- and we round out the episode, with Lewis providing some golden tips for how nurses and doctors can work cohesively as a team.
Working in Resus: Update
International Men’s Day - Special Guest: Luke Yokota- ‘Men in Nursing’ campaign
Welcome back to another episode of the New Grad Radio podcast! November 19th marks International Men’s Day. In celebration, I interview Luke Yokota. Luke is a third year RN, and a fellow ICU nurse. Luke is the driving force behind the ‘Men in Nursing’ campaign through the Australian College of Nursing (ACN). Luke has also recently been nominated for Queensland Young Australian of the Year awards. Luke is a passionate nurse, and top bloke, and I can’t wait for you to hear from him today.
Here is the link to check out Luke's Initiative: The Men in Nursing Campaign - www.acn.edu.au/men-in-nursing
If you have any questions for either Luke, or myself, please don't hesitate to contact me via the Facebook page: search 'New Grad Radio'.
I’m Back in ICU (and still in ED)
Military Nursing Course
First Resus Shift
Graduate Nursing Program Application: My First-Hand Experiences
Walk to work - How I prepare for Night Shift
Working with Student Nurses
Officer Training
Thank a Paramedic Day! 🚑
The Difference a Day Can Make!
Time Management and how my perspective has changed
Ambulatory Care
Walk to Work - How I Start each Shift
Getting sick as a Nurse - Is it only a matter of time ?
No More Assignments...A Challenge?
4 Months - Starting to Settle In - why has it taken so long?
Special Guest: Dr Pauline Calleja - Post Graduate Qualifications
Trauma Systems Assessment + Alarm Parameters
Special Guest: Charlotte Stephenson - Midwife 🇦🇺
The role of a registered midwife, takes these professionals further than the birthing suite. Charlotte outlines the variety of roles she plays from day-to-day when caring for her pregnant patients, from the emergency department, to post-birth.
We go clinical, with Charlotte answering a few of my burning questions, including: what we could be looking out for for the woman with abdominal pain; and how we can deliver an effective handover to the midwife. Charlotte also highlights a program we, as ED nurses, could participate in to help with our assessment skills and management of obstetric emergencies; as well as how midwives fit into the treating team for such emergencies.
As you'll hear, midwives face the same 'types' of challenges when entering the profession, with Charlotte speaking on her experiences of starting as a new graduate nurse, how she deals with stress, and offers advice for graduates about to follow in her foot-steps. Thank you again Charlotte for being a guest on the podcast!
Special Guest: Lauren Philpott - Paediatric Nurse & Published Author 🇬🇧
Welcome back to another episode of the New Grad Radio Podcast. In celebration of International Nurses Day, I chat with an incredible paediatric nurse, hailing all the way from the United Kingdom, Lauren Philpott.
Lauren is the Author of 'Being a Nurse: From Graduation to Revalidation', a book aimed at providing a real-perspective of what it's like to start as a new graduate nurse. As I mention in today's episode, as I was reading through, I kept thinking to myself just how much this related to how I felt when first starting. This book is littered with golden advice, and encompasses topics such as 'what to expect during your first shift', to 'conflict management'; as well as a lot more, all from Lauren's personal experiences.
Thanks again to Lauren for being on the podcast today. Here is a link below to how you can purchase Lauren's book:
- www.lanternpublishing.com/titles/401-9781908625533-being-a-nurse (non-sponsored - just highly recommend the read).
Special Guest: Christine Hicks - Neonatal Intensive Care Unit (NICU) 🇺🇸
In today's episode, I speak with Christine Hicks. Christine is about to finish her Graduate Nursing Program, commencing her career directly into a Major Trauma Centre's Neonatal Intensive Care Unit (NICU) in America 🇺🇸 .
Christine highlights her reason for entering nursing; a clinical placement in South Africa that cemented her drive for pursuing NICU; How Christine prepared for starting her graduate program; how Christine overcomes stressful situations and manages her time; along with A LOT more.
This episode is full of absolute Pearls of wisdom, from an incredible nurse. I admire Christine's passion for nursing, and true desire to help others.
INTERNATIONAL DAY OF THE MIDWIFE & INTERNATIONAL NURSES DAY - Preview
Conflict Resolution
A Typical Bed Space in the Emergency Department
Rapid Response Team
ALS Training Day
Transitioning into ED - differences from ICU
Anatomy of the Emergency Department
Mental Health Emergencies
Special Guest: Hannah Cotterell - Paediatric Emergency Nurse
In the episode today, Hannah elaborates on her own nursing journey, including a job she held whilst at university which has helped her immensely; an exciting two-week placement in Cambodia; as well as some first-hand experiences and advice that I think is absolute gold for anyone to hear.
Whether you are a student nurse with an upcoming paediatric placement; a student, or registered nurse considering a transition into paediatric nursing; or simply after a little more information on the career of a nurse working in as a paediatric nurse in a busy Emergency Department, I believe you will have many take-aways from Hannah's words of wisdom.
As always, thank you very much for listening, and if you have any comments or questions, please do not hesitate to send a message through on the Facebook page: search "New Grad Radio Podcast". This was my first attempt at interviewing, with there being a few clunky sections; but just like nursing, with a positive attitude, and persistence, it’ll only get better! Thanks to Hannah for her patience.
Show Notes:
Here is the link to the Royal Children's Hospital website that Hannah mentioned:
- www.rch.org.au/clinicalguide/about_rch_cpgs/welcome_to_the_clinical_practice_guidelines/
There are also some apps you can download on IOS and Android devices: search 'RCH Clinical Guidelines', as well as ‘Emergency Nurse Practitioner’.