E.B. Writers of Dallas

By Esther M. Bauer

PULSE Magazine, a Dallas Morning News publication, May 2003

Technological advances in equipment, medications, and patient-care procedures have made critical care units among the fastest-paced areas for nursing and among the most severely affected by the nursing shortage.

The advances have almost made the shortage of experienced specialty critical care nurses more acute as the training is demanding, lengthy, and the work is intense. It involves a hospital’s sickest patients – from neuro and cardio units to neonatal intensive care units for pre-term infants. Depending upon the ICU and the patient’s acuity, the staff ratio can be one nurse per patient, or even two nurses, but the standard is one nurse to two patients.

“The biggest issue relates to staffing and the ratio of patients to nurses, the recruitment and retention of experienced nurses, and the training of graduate nurses into the specialty,” says Damon Cottrell, president-elect of the Dallas Chapter of the American Association of Critical-Care Nurses.

Cottrell, MS, RN, APRN-BS, CCNS, CCRN, CEN, is also a clinical specialist in critical care/​cardiology in charge of training critical care nurses at Presbyterian Hospital of Dallas, a Texas Health Resources facility.

“What makes the nursing shortage so bad is the acuity of patients. We are seeing patients who several years ago probably would never have made it to the ICU. The advances in medicine and technology require an incredible amount of knowledge that critical care nurses have to gain and keep updated on,” Cottrell says.

Due to the increased acuity, ongoing training to ensure nurses remain competent in their specialty is more crucial now than ever. Hospitals provide in-service training for increasingly complex technological advances and new medications seemingly are introduced every day.

Shorter hospital stays pose challenges, too. Patients are now discharged days after open-heart surgery, and critical care nurses have to prepare them for that.

“A critical care nurse is expected to accomplish today almost the impossible in the time frame given. We are not only responsible for taking care of the patients, but the patient education is packed into such a short time that sometimes it is difficult for the patient to retain all the information they need,” he says.

The importance of critical care nurses is probably most apparent in neonatal units where pre-term infants weighing less than a pound are not only kept alive but nurtured and matured into healthy infants who eventually go home.

Among the trends in that area are advances in the developmental care of infants, new medications and the design of equipment by neonatal critical care nurses, says Aziza Young, RN, MS, nurse manager of the neonatal ICU at St. Paul University Hospital.

“The equipment is now being designed by nurses, who know the special needs of pre-term babies. That is such a plus,” Ms. Young says.

The latest such equipment is a Giraffe OmniBedtm, which its manufacturer describes as a full-featured incubator and radiant warmer in one compact mobile environment that is the baby’s home throughout the hospital stay. Its name is derived from the long-necked animal, but in this case the neck lowers or raises the warming apparatus as necessary so the baby can be treated without moving it from the bed. It offers an incubator option, and the bed rotates, not the baby, for complete access.
The $35,000 bed was part of a donation by Dallas resident Betty Omsted Taylor, 67, who, born prematurely, at only 2 and one-half pounds, donated $1,000 to St. Paul for each year she has been alive. St. Paul will be purchasing nine more of the specialty beds later this year.

Another advance involves developmental care and another animal, the kangaroo, or rather the way the animal cares for its offspring in its pouch. Kangaroo care tries to mimic that effect for pre-term babies as an alternative to the mother’s uterus. Most of the time the baby is wrapped into a bundle, arms and legs tucked together, similar to the posture inside their moms, and when the baby’s medical condition allows it, the baby is tucked skin-on-skin inside the parents’ shirt, mother or father.

“Kangaroo care encourages bonding between the mother and the infant. It helps the infant to regulate its heartbeat, its respiration; it helps the infant to go into a deeper sleep pattern so that it will grow better. It also increases the mother’s milk supply if she is breastfeeding. It has a lot of positive aspects for both parent and infant,” says Mary Johnson, RN, charge nurse.

Babies under two pounds and on a ventilator benefit from such care, she says.

Part of developmental care includes coordinating the care to decrease the number of times a baby must be disturbed for evaluation, vital sign checks, or respiratory therapy, says Kim Phelan, RN, charge nurse.

“We are not waking the baby up now, and then 15 minutes later someone else is bothering the baby. We try to do all that care together to give them a long rest period,” Ms. Phelan says.

The point of developmental care is based on mimicking as closely as possible the environment inside their mom, says Ms. Young. “We try to give them long periods of rest in a warm, swaddled, quiet, muted light environment. It helps them to develop better.”

The single most important aspect of any critical care nursing, regardless of the specialty area, is ongoing training to keep up with the latest advances, says Cottrell of Presbyterian.

“The critical care nurse is he one at the bedside 24 hours; the physicians are in and out. It really is ultimate responsibility of the nurse to make sure that any even subtle changes are reported to the physician. The critical care nurse is responsible for lives of the patients. Overall we do a great job.”