Top 10 Hard Core Clinical Skills Every Critical Care Nurse Must Develop.
By,
Ayinla Daniel. RN.
These skills make you a lifesaver. You are a superhero because you have got these skills.
In Critical Care, time is tissue! The more time we waste, the lesser are our chances of saving that life!
Now, let’s go on a rush ride, as I quickly drag you through this article!
These are the skills we will be looking at:
- Speed Assessment.
- Advanced Airway Management.
- Advanced Cardiovascular Life Support.
- Advanced Wound Management/Trauma Care.
- Advance Venous/Arterial Access Skill.
- Advanced Hemodynamic Monitoring Skill.
- Basic O&G Skill.
- Use of Common Health Technologies.
- Basic Interpretation of ECG’s & Ultrasounds.
- Handling of The Mentally Unstable.
Speed Assessment.
Assessment is the backbone of clinical practice. The clinician must be able to take a critical look at a patient and quickly determine the clinical state of the patient. This will enable them to immediately draw out a line of action.
Critical care nurses must be able to speed assess patients who are receiving care in critical care settings; Intensive Care Units, Coronary Care Units, High Dependency Units, etc.
They must train their senses to quickly detect life-threatening changes and quickly do something about it!
If you know that you are lacking in your assessment skills, and you work in the critical care setting, I bet you want to work on that immediately! You never can tell, the life of someone may be saved by your keen sense – your ability to detect anomalies in patients physiological status.
Advanced Airway Management.
Airway management is a vital aspect of critical care. An open/patent highway is our first and topmost priority. The first thing we do for a critically ill patient is to ensure that they have a patent airway that is open – enough to allow oxygen to enter the lungs and carbon dioxide leave the circulation.
Critical care nurses must know how to manage advance airways, especially taking care of tracheostomies and other types of advance airways. And in some tough settings, they must be able to establish advance airways; Intubate, or use other advance airway devices.
Critical care nurses must know when a patient needs an advance airway, this also bothers on the assessment skills we talked about. This skill may be the key to saving a life! Don’t joke with it!
Advanced Cardiovascular Life Support
Circulation is also very vital in critical care. Critical care nurses must know and master the algorithm used in resuscitation and subsequent monitoring of the circulatory functions of patients in critical care settings.
A patient suddenly goes into cardiac arrest, and you are the closest professional, what do you do? Call the doctor? In critical care, we are concerned about life and safety! You immediately put the algorithm to play and do all you can to keep blood circulating through the vessels of that patient, remember, time is tissue!
Sufficient knowledge in basic life support, advance cardiovascular life support and paediatric advance life support are essential “know-hows” for critical care nurses.
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Advanced Wound Management/Trauma Care.
If you call your self a critical care nurse, then you must be able to handle trauma cases. Most trauma cases come with the presence of physical assault, with damage to tissue and sometimes bony tissues, here I streamline trauma to a very narrow domain, excluding other traditional descriptions of trauma.
You are in the emergency room (which is also critical care) and suddenly a patient comes in with compartment syndrome [e.g fracture to the humerus showing bleeding into the muscle tissue; internal haemorrhage], and from history taking they have been bringing her from let’s say a kilometre away, what do you do? Knowing very well that further delay can lead to tissue necrosis, and you work in a facility that is obviously understaffed! what do you do? As a critical care practitioner, you should know what to do to save that limb or body part.
Simple suturing skills is also a very vital skill all critical care nurses must have. Basic surgical skills are a necessity if you really want to enjoy critical care! It is called critical care for a reason!
Advance Venous/Arterial Access Skill.
The nursing profession is advancing rapidly. Many clinical skills that were exclusively meant for the Physicians to handle, are now beginning to enter the practice domain of registered nurses, because the system has started to realise how important it is for some of these basic critical skills to be readily accessible in the clinical settings, especially in critical care.
Intravenous access skill is a must have for every critical care nurse. In some countries, Registered Nurses are trained and licensed to establish Central Venous Access and Arterial Access.
In some hospitals in Nigeria, Registered Nurses are barred from establishing venous accesses. The policies in these hospitals [Government owned and some private hospitals], make it impossible for Registered Nurses to set up a simple “Intravenous Access” and it may surprise you to know that some of these hospitals do not even allow Registered Nurses initiate intravenous therapies – pretty funny though. And guess what happens in emergencies? when a patient who is dying needs urgent resuscitation! the Registered Nurses start running around looking for the Medical Officers to come around and establish Intravenous access to help them in resuscitation, you know how this sounds like to me?
Advanced Hemodynamic Monitoring Skills.
In critical care, we are so much concerned about the haemodynamic functions of the patient, because if a patient is haemodynamically stable, we do not have much to be afraid of.
All critical care nurses must be perfect when it comes to the clinical business of monitoring haemodynamic. They must know how to interpret ABG’s, read ECG’s, know when they have to worry about the CVP and the urine output, know which medications are improving haemodynamic or causing it to go the other way.
Basic O&G Skills.
We are all midwives. You never can tell where you may find your self someday, maybe right in front of a woman who has been arrested by the pangs of labour. This is also critical care, well, that’s the way I see it, I do not know what you may be thinking about, but to me, midwifery is critical care.
All critical care nurses should have or better put, should develop basic obstetric and gynaecological skills. At least, know how to take a normal delivery. Nobody is saying you should know how to give an Epi, just know how to get the baby out first, saving mother and child. If you know you are rusty in you O&G skills, which many of us are [I am very guilty here], then I believe it is wise if you begin to brush up on them.
Use of Common Health Care Technologies
You should be able to handle most of the equipment used in the critical care setting, ranging from injection pumps, syringe pumps, cardiac monitors, oxygen apparatuses, ICU Beds, Arterial Blood Gas devices, Dialysis Machines, ECG’s, AED’s, and other basic or common health care technologies that are used in critical care. And don’t forget to also get acquainted with the health management systems available in your facility.
Basic Interpretation of ECG’s & Ultrasounds
The ECG is the graph of Critical Care medicine/nursing. A good command of interpreting ECG’s is a life saving skill. The critical care nurse is able to detect life threatening arrhythmias and quickly intervene.
ECG’s give us a graphical representation of the electrical activities of the human heart. It may not give us much details, as compared to an Echocardiograph, but it is a very useful tool that can enhance assessment in critical care settings. Ultrasounds are important clinical assessment tools, and I recommend that critical care nurses should be able to interpret the strange and funny shades that appear on an ultrasound screen.
Handling of The Mentally Unstable
I know you were not expecting this particular mention, but it is also very important. You never can tell what kind of patient you are going to be taking care of in the critical care unit.
Though in psychiatric medicine/nursing, they is special skill needed to take care of mentally deranged patients who are critically mentally unstable. The critical care nurse must be armed with enough psychiatric knowledge and skill to be able to intervene should in case things go out of hand in the critical care unit.
This brings us to the end of my list. I believe you have learnt some things from all I just discussed. If your know that you lack in a specific area, it is wise that you start making appropriate moves now!
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Ayinla Daniel. RN.
