intensive care unity - Lamp Online

A new nurse tells her story of beginning work in intensive care.

It’s been nine weeks since I first landed at the Intensive Care Unit (ICU) at Nepean Hospital.

I remember feeling very scared in the beginning. I felt I had been taken out of my comfort zone. I have been an EEN for three years but have mainly worked in the wards.

I spent my first 4 months as a new graduate in Endoscopy, so ICU is definitely a whole new unknown world for me. The orientation helped a lot, plus the one week I am supernumerary – I worked with a nurse buddy for the whole shift. My buddy showed me the basic stuff and the routine.

Now, after nine weeks working in ICU, I am ready to give you an idea of what a day in the life of an ICU nurse is like…

At the start of each shift we get the complete handover at the nurses station, then a bedside handover of the patient (ventilated)/patients (non-ventilated/cleared for ward) we are allocated for the day.

I start by doing a complete physical assessment on my patient. I also check my equipment and set my alarms. I check what drips are running and label each line, especially if the patient has central line with chooks foot extension.

Then I update my ICU flowchart, follow doctors’ orders for the day, administer medications due.

When it’s quieter, I focus on patient care. I give them a wash or shower, whichever is applicable. Oral, eye and pressure area care is very important, especially with patients on ventilator support.

We always put them on special mattresses and sequentials to assist with circulation. We encourage relatives to visit as this assists the patient’s recovery.

Most ICU patients feel isolated and helpless, they lose their confidence and interests. Lack of sleep is also a big problem due to the noise of alarms and the bright lights and constant prodding by nurses, doctors and physios.

I can relate to this so whenever I can, I give my patients time to rest and sleep by reducing the background noise and turning down the lights. The last thing I do before leaving the patients is make sure that they have enough pain relief if they need it.

The last part of my shift is spent documenting everything I did for the day. Then I know I’m ready to hand over my patient to next nurse.

An enterprising nurse shows how a strategy for reducing waste can save hospitals money, reduce emissions, and improve staff morale.

Libby Barnes, an RN at Lismore Hospital’s Intensive Care Unit, initiated a recycling program that saw her unit transform from one where the only things recycled were cardboard boxes when a staff member moved house, to one where almost half of the unit’s waste is now reused and recycled.

“We did an audit in 2016, and there was nothing being recycled,” Libby told NSWNMA members at an Environmental Forum.

“Twelve months down the track, at least 40 per cent of waste was being recycled, and close to 50-55 per cent on big weeks,” said Libby, who has now taken the program to the rest of the hospital.

The recycling company would once pick up two skips three times a week. Now they have added another big skip and come five times a week, she explains.

The amount of material now being recycled means the hospital is well on the way to meeting the service agreement it has with NSW Health to reduce landfill by 40 per cent by 2020.

Libby first discovered the agreement existed when she started looking into recycling at the hospital. She realised Lismore was “nowhere near meeting this and there was nothing in the future. It was just brushed under the carpet”.

As the “biggest industry in the region”, Lismore hospital’s environmental footprint is significant. “We have a huge responsibility in healthcare to minimise our impact on the environment,” she said.

Before she became an ICU nurse, Libby had worked for Greenpeace, The Wilderness Society and the North East Forest Alliance. With this strong green background, her first day of practical in 2000 came as a shock.

“There was just this sea of waste in front of me, everything I opened was a once-only object.”

She thought: “I can’t do this, I can’t enable it.”

When she started the recycling program at Lismore, Libby remembers standing in the pan room with a fellow nurse and “looking at the skip overflowing with recyclable materials”.

ICUs can create up to 6 kg of waste per patient per day, Libby says. Sixty per cent of that waste is potentially recyclable.

“Everyone is worried about the potentially pathogenic nature of hospital waste, but studies show that only applies to 15 per cent of hospital waste.”

One of the big lessons Libby has learnt from this program is that environmental practices start with procurement: “Buying practices can contribute up to three quarters of a hospital’s carbon emissions.”

Libby has now begun auditing products purchased by the hospital and researching more environmental alternatives. Individually wrapped tourniquets can be replaced with boxes for each patient, for example.

Disposable cups have been replaced with re-washable ones, and plastic medication cups have been replaced with biodegradable paper cups. Large packs of five different types of instruments that would be thrown away when only one was used have been replaced with smaller packs.

“We can save money, reduce emissions, and it also really improves staff morale,” says Libby.

Staff and patient surveys have shown unanimous support.

“Everyone loves it. They own it, they really feel proud of it.”

Find out more

You can listen to a broadcast of Libby’s presentation to the NSWNMA’s Environmental Health forum at: http://www.nswnma.asn.au/podcast-environmental-health-forum-the-green-line/

Libby’s tips for starting a green hospital program

Do an audit before you start: Get evidence-based research on what needs to be done

Make sure staff nursing managers and hospital executives are on board and get their approval: Ask the recovery facility people to send in the right experts to tell you what can be recycled

Communicate with cleaning staff and ask for their input to make sure that it works: Make sure bins are well-placed and well-signed with exactly what goes in every bin (especially important for new staff)

Money and volume talks – show management how environmental practices make economic sense and demonstrate the result

Nine weeks in – a newbie ICU nurse’s story

Reducing a hospital’s environmental footprint