HCDM 60 | Intensive Care Unit

 

What is it like to be a nurse in the Intensive Care Unit? It’s exciting, gratifying, and exhausting. Enter Tina Vinsant, a Cardiovascular Intensive Care Unit Nurse in Tennessee and Podcast Host of Good Nurse, Bad Nurse. Tina talks with Richard Marn, MD, about how a big part of being a nurse is to help people be comfortable with being vulnerable. It can be highly embarrassing for patients to have someone clean their bodies for them, and it’s crucial to use your emotions to empathize with them. Join in the conversation to hear more stories of what happens behind the ICU curtain. Don’t miss this episode!

Listen to the podcast here:

The Gratifying Life Of A Nurse In The Intensive Care Unit With Tina Vinsant

We have a wonderful guest on this episode. She is not only inspired by her work but she also inspires a lot of other people outside of work, as we will soon find out. This profession is about nursing, specifically a nurse that is taking care of the most intense and most critical patients. What we’re going to talk about is being a nurse in intensive care, specifically a cardiovascular intensive care unit nurse.

We’re going to talk with Tina Vinsant. She’s a Cardiovascular Intensive Care Unit Nurse in Tennessee. She brings a real perspective to this profession because she has not only great stories but she loves what she’s doing. She studies what she’s doing even after work. She self describes herself as a nerd, if you will. She says that with pride. She also has a different trajectory on how she got to nursing as well. We’ll explore that later on in the podcast.

We’ll learn not only what it’s like to be a nurse but also be an intensive care unit nurse and how it is not only for the intense patients but how the environment itself can be intense for the staff and the nurses who are working there and how that can be so fulfilling. It’s a bit of an adrenaline rush and exciting. Knowing that you’re taking care of patients and making decisions for their care can be life-altering for these patients because of what you’re doing and how you’re taking care of them. This is an important role in health care that these nurses have. I’m excited to have Tina on.

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Thanks for joining me. I have another wonderful guest, Tina. She’s a nurse from Tennessee. Tina, do you mind introducing yourself?

First of all, thank you for having me. I appreciate it. I love going on other podcasts. I’m an intensive care unit nurse in Knoxville, Tennessee. I’ve been a nurse for a little over six years. I went to nursing school a little bit later in life after my children were older. I’ve pretty much been in progressive care. I stepped down for about four and a half years. I’ve been in ICU for over one and a half years. I’ve started doing travel nursing.

New changes, that’s awesome. Let’s go through some quick questions about your profession. As a nurse, what do you do clinically? How do you help people in healthcare, specifically your type of profession and what you’re doing?

When you feel that what you do makes a difference, you experience immediate gratification. Click To Tweet

I work in the cardiovascular intensive care. That is specialized. We see a lot of open-heart surgery patients. They come directly into the CVICU from surgery. They don’t go to PACU. They don’t go to recovery. They come right out. It’s a big ordeal. We make a big display of it at UT. There are lots of drama and the nurses love it.

Usually, if you are an intensive care unit nurse, you’re going to be highly motivated, type-A, a perfectionist because you want that control. Also, you like a little bit of adrenaline and you like to use your critical thinking skills a lot. Although a lot of nurses do still have to use critical thinking skills. In intensive care, you’re the eyes and ears for the doctors and you have to be able to recognize things quickly. Changes can happen quickly in patients and you want to catch everything as early as you possibly can and not wait until it gets to the point that anybody could recognize that there’s something wrong. You want to be able to see the subtle changes. That’s challenging.

I love it and most intensive care unit nurses that I know, that’s what they love about working at the bedside in intensive care. It feels like you’ve got a puzzle to put together almost. You’re looking for all those pieces and helping the doctors that can’t be at the bedside. I know people that don’t work in hospitals think they’re doctors. I honestly thought that. Later in life, I was shocked when I got out of nursing school. I was like, “Where are the doctors? Are you kidding me? Where are they?” There are only so many of them. They can’t be at the bedside. That’s not their job.

You guys are there. What are the usual steps to achieve your professional degree?

There are a few paths to being a nurse. There used to be a path that was what they would call a diploma nurse, where nurses would go through a program at a hospital. It was hands-on. They would get a diploma and become a registered nurse that way. At some point, that became less and less common and nurses were going to college and universities to get their degrees.

As far as I know, I don’t think there are any programs like that. You have to have at least an Associate’s degree to be able to become a registered nurse. A lot of hospitals, especially the larger teaching hospitals, are requiring a Bachelor’s degree to be able to work. You can sign on with an Associate’s degree but then they require that you say that you will get your Bachelor’s within a couple of years. That’s how it is.

I will say that Associate’s degree nurses are as capable of as Bachelor’s degree nurses caring for patients because you get all of the clinical in those years. The Bachelor is all that other stuff. You get the information that you need to lay the foundation for becoming a nurse in those first few years. Associate’s degree and Bachelor’s degree are the same as far as bedside and taking care of the patient.

HCDM 60 | Intensive Care Unit

Intensive Care Unit: If you’re an intensive care unit nurse, you’d want to be a highly motivated perfectionist because you’ll want control.

 

Gain those degrees in nursing and then you can start working as a nurse once you pass a state exam, I presume.

Yes, you do have a state board. You go to your university, you get your degree, and then you do have to pass the NCLEX. It is not an easy test. If you have a good nursing school, you’re going to be prepared to be able to take that test. Once you pass that, you can start working at the bedside as a nurse. You should have an extensive orientation before you’re put out on your taking care of patients.

What’s the best part of being a cardiovascular ICU nurse?

The best part about being an intensive care unit nurse, in general, is that intense situation, the circumstances where the patients can be unstable, and you feel like you’re making a huge difference. You can see an immediate change because if their blood pressure starts to drop, you do something to fix it quickly.

There is a certain satisfaction that comes along with that, especially if you recognize your patient’s lungs are starting to sound wet. They’ve been getting 150 ml of normal saline in an hour for a while. You turn the fluids off and then you call the doctor and they say, “Give him a Foley of Lasix.” You give them that. All of a sudden, the Foley starts to fill up and they start breathing better. You get that immediate gratification to feel like what you do is making a difference right then.

You have an immediate impact. What’s your least favorite part of your career?

This is probably pretty common with most nurses. What I hear, especially in CVICU, is, “I want it and I don’t want it.” It’s hard to explain but you want the adrenaline, you want the responsibility, you want to use your brain, and it does feel good for a time but it is also extremely scary. With your emotions and adrenaline rush all the time, it wears you down. Sometimes you like a break. When you get floated maybe to another floor or even another unit, you don’t have that as much.

You can relax and you’re like, “It’s nice to not be constantly thinking about the hemodynamics of everything and what’s going on.” They come out and they’ve got every kind of tube you can imagine. You’re monitoring them and you’re having to think about where they are hemodynamically and what is going on with their fluid volume, status, their electrolytes, all those things. It’s taxing on the brain and you love it. At the same time, it gets exhausting, and you need a break from it sometimes.

To give some readers some perspective, for someone coming out of cardiovascular surgery, that’s some of the most intense surgery that a patient can go through. Bringing that patient to the intensive care unit right after, you have to carry over some of that intenseness into the ICU. For someone like Tina, being involved in that, it’s important to know what’s going on and how to manage them. It does take a team effort to make that transition from the operating to the ICU. For people to understand, this ICU business is a big deal. You’re getting very sick patients in that setting. You’re highlighting that. What are three highlights about your profession that people should know, Tina?

I say this on my podcast because there are a lot of people that are thinking about going to nursing school. What I try to say is, number one, if you’ve never experienced a hospital, nurses do a lot more than what most people even understand. They have to have a knowledge and skillset that most people don’t realize what we know. Our jobs are not holding the patient’s hands and being the assistant to the doctor and doing whatever the doctor says to do.

A big part of being a nurse is to help people be comfortable with being vulnerable. Click To Tweet

We are colleagues of physicians and we use our brains and we use our critical thinking skills. That is not just in intensive care but it’s every aspect in the hospital like working at the bedside. Med-surg nurses work hard. It’s difficult. They have 5, 6, 7, 8 patients and they’re still doing this. Doctors cannot be there all the time. You have to be able to recognize subtle, acute changes, and then relay them back to the doctor.

Sometimes doctors are inexperienced. Believe it or not, they do heavily rely sometimes on nurses too, especially if they are comfortable with the nurse and they know the nurse. They will rely on you, “What are you thinking? What do you think they need?” If you’re confident and you’ve been doing it a while, you’re like, “They need Lasix. They sound terrible.” They’ll be like, “Let’s do that.”

It’s not that the doctor didn’t already know that but they’re allowing you to use your critical thinking as well. What good doctors will do is if you say something wrong, they might judge you for it but they will help you understand why what you said was wrong. They might say, “I see why you would say that but here’s a better idea and this is why.” You’ve then got a little more knowledge in your toolkit for the future as you’re taking care of patients.

If you are thinking about going into nursing, understand that it’s a huge responsibility to work at the bedside. Also, there is a lot of hands-on. This is something I honestly didn’t know either on what I thought nurses did. I remember the first time I started. I was in nursing school and we went to clinical and there was a patient there who had diarrhea. She had C. diff. I remember being like, “Do we clean them up? I didn’t know that.” I remember being shocked. I had never done anything like that in my entire life.

Here you are doing it for a stranger.

For babies, not an adult, I can remember being shocked. At the end of the day, this person was over 300 pounds and they had C. diff. It was almost a constant flood. At the end of the day, the clinical instructor knew how shocked I was, and she said, “Are you still good being in nursing school?” I said, “Yes. I love it. It’s great.” It was shocking but I realized something about myself. I love taking care of that person, getting in there, and putting them at ease. That’s a big part of being a nurse. You’re using your brain but you also use your emotions too.

You have to empathize with people. Sometimes they can be in humiliating situations. They’re vulnerable. Putting them at ease is important and to be able to say, “I know this is embarrassing.” They’ll be like, “I’m embarrassed.” I’ll be like, “We do this all the time. It’s okay. This is my job.” I tell people all the time, “I went to college for four years to learn how to do this. It’s fine. I promise. If I didn’t want to do it, I wouldn’t be doing it.” A big part of being a nurse is helping people be comfortable with being vulnerable.

It’s not easy. To let people and know, C. diff stands for Clostridium difficile. That’s a type of bacteria that you do not want to get. It can make people have, as a symptom and sign, diarrhea. That’s what C. diff stands for. What’s your typical day like as a cardiovascular intensive care unit nurse?

That varies a lot. It depends on your level of training. CVICUs are probably different from hospital to hospital. First of all, I had been a nurse for four and a half years and I still had another 3 to 4 months of orientation that I had to do because it is different and intense with the drips and the things that you’re doing. The things that you do with these patients manipulate their blood pressure, their heart rate, and things like that quickly. You have to be able to watch them closely.

Even if you’re an experienced nurse, they don’t just throw you in there. Also, they don’t give you an open heart patient the first day either. At first, my patient load will look different. It may be a patient who has been there for a couple of days and now they’re ready to go to the floor. Maybe they’re still on a little whiff of Levophed or norepinephrine that’s helping to keep their blood pressure up a little and then you wean them off. You’re learning how to titrate those drips and what is normal for this drip versus that drip because there are so many different ones.

By the time I had been there for a year and was trained in all the different areas, I was taking ECMO patients, open-heart patients, CRRT, which is like dialysis at the bedside. When you first get there in the morning, you’ll never know. There are always these butterflies in your stomach because you don’t know what the day is going to hold. Every day is different.

You then get a report from the night shift person and they give you all the details of what’s going on. What’s the background that’s going on? What brought them in? Where are they now? What are we trying to do for them now? What are our goals for the day? The first thing you want to do as a bedside nurse after you get the report is to be thinking about, “What can I do to help this person get better?”

HCDM 60 | Intensive Care Unit

Intensive Care Unit: A nurse’s job is to do everything they can to make progress for the patient and help them become better.

 

A lot of times, if they’re on a ventilator, I want to get them off the ventilator. I don’t want them on the ventilator. That’s not good for them. We need to make progress. I see my job as trying to do everything that I can to make progress for the patient and get them better. The first thing I start thinking about is I’ll contact the physician and be like, “Are you wanting to start weaning sedation? Do you want me to turn it off? Do you want me to talk to the respiratory therapist about doing spontaneous breathing trials to see how they do?” That’s what you want to do.

You got to start that early in your day because even though you’re there for twelve hours, it goes by quickly. If you wait too long, you lose your window to be able to make big changes like that for them. Maybe something happened overnight and the nurse is saying, “I’m worried about them. I let the on-call person know but they were wanting day shift.” You wouldn’t believe some of the stuff that happens. It’s your job to be calling the doctor and going, “At some point overnight, they started having this problem.” They’re mad, “Why didn’t they do something?” “I don’t know. They wanted to wait for you to do it.” You get to handle it.

I love how you look at that where you say, “I want to make progress today.” It’s not like, “I’m going to dot the I’s and cross the T’s.” It’s like, “I’m going to try to make progress in the patient’s care.” I love that perspective. To clarify, your day as an ICU nurse is shift work. You start at 7:00 and end at 7:00. Is that pretty typical?

Yes. It’s typical for most ICUs.

If that’s the case, what’s your work-life balance as an ICU nurse?

The nice thing about working twelve-hour shifts for nurses is that we only work three days a week. You have four days off unless you choose to pick up extra shifts. That’s nice. It helps with work-life balance. You usually are going to have to work a couple of weekends a month for weekend shifts. It depends on how you look at it. Even if you have young children that are in school, sometimes it means that you can be there for things that are going on during the day.

You can take snacks if they’re having a birthday. You can be there for a play in the middle of the day. If you work Monday through Friday, 8:00 to 5:00, a lot of times, you have to either schedule around that or miss a lot. There are advantages and disadvantages to both. I personally like working twelve-hour shifts because it gives me a lot of free time.

Of course, you can work more than that. You can work less than that if you want to do so. There’s a lot of flexibility in being a nurse in terms of your schedule. What are some misconceptions people have of being an ICU nurse besides cleaning up poop?

That’s a big one. I don’t know if a lot of people don’t realize that but that’s a big part of the job. A lot of nurses think that they shouldn’t have to do it. Maybe it’s the CNA’s job or whatever. ICU nurses are control freaks. A lot of them wouldn’t want anyone else doing it because they want to make sure that someone doesn’t accidentally extubate their patient. They get protective. It’s like, “I’ll do it. I’ll clean them up.” Maybe you’ll have help.

There's always something you can do when you help out other people. Click To Tweet

A big misconception if you’re a nurse working at the bedside and you’re not in ICU is like, “You only have two patients. How hard could that possibly be here?” I don’t care how hard it is or what drips are on you. It’s two of them. I have seven. I know that’s what they’re thinking because I’ve heard them say it. On PCU, we have three patients. That’s where I worked for the first four and a half years. We have 3 to 4. A lot of times, I couldn’t imagine how much more difficult it could be for myself. If you have one CRRT patient, that’s like dialysis, you never stop. There are some days I can have one ECMO patient and I could never sit down.

Sometimes you need another nurse in there to help you.

Believe it or not, I know that sounds crazy, but it’s almost a non-stop drawing blood for labs every hour. Sometimes, depending on how unstable they are, hanging every drip and electrolyte that you can imagine, you wouldn’t think so but you’re almost busier in an ICU and have fewer breaks. When I worked in PCU, I almost always got to lunch.

What is PCU?

It’s Progressive Care Unit.

Is that a stepdown?

It is. Patients who are ready to come out of ICU, maybe go to the cardiac stepdown or go to the trauma stepdown or neuro. They’re ready because they’re more stable but oxygen-wise, they’re still on a Vapotherm, a heated high flow nasal cannula, or having to be on a BiPAP pretty often. If they’re not stable respiratory-wise, they will go to the PCU. Also, they can do trach ventilators for patients that have trachs and handle a lot of different drips.

It’s very much critical care but they’re more stable. There’s still a lot of instability in these patients. It’s busy. There’s a lot of chronic comorbidities and it’s a busy floor. Even then, I almost always get lunch. You get breaks. You have lulls in between. In ICU, sometimes you don’t stop your work. You start at 7:00 working and doing one thing after another for both your patients. By the end of the shift, you’re like, “I meant to do this. I didn’t get to do that.” It’s very busy.

No time to check your social media.

Not that there ever isn’t, sometimes there are lulls in ICU too. For whatever reason, maybe your patient doesn’t need to be extubated. Maybe the doctor is going, “They’re not ready for that. Their RSBI is way too high. We can’t do that today.” Your goals change. You can’t progress them beyond that. You’re keeping them stable. You’re still monitoring.

If their electrolytes and fluid volume status are fine, you’re handing their antibiotics and making sure they’re turned, so they don’t get a pressure ulcer and that sort of thing. Yes, there are times when you can have lulls and you can find yourself being like, “I’ve got both my patients. Here I am.” That’s when you usually help out other people. There’s always something you can do.

It’s important to highlight that even though the intensive care units are intense and you’re doing a lot for these patients and there’s a lot of 1 on 1 or at least 1 or 2, you’re still working very much as a team. You’re not alone. There are other nurses, physicians, or assistants that are around to help you out. Would you say that’s true?

Yes. I am doing some travel nursing right now. I’m in a small rural hospital, and the ICU that I’m working in is a six-bed unit. Sometimes if we only have 1 to 2 patients, then there is just me in there. If I was not an experienced ICU nurse, I would be scared to death to be in there. I’m still scared sometimes in there by myself. Even not having help to turn the patient and trying to do it by myself can be difficult. Most hospitals in the ICU, at least, are going to have two nurses and maybe a CNA depending on how large the unit is. Especially at teaching hospitals, most of those units are going to be large 20, 24, 30-bed units. There are people everywhere.

Changing gears a little bit. Tina, let’s talk a little bit about the outlook of the profession. What do you think the future outlook is like for an ICU nurse?

This question is hard to nail down because it’s uncertain right now. I would have answered it differently before COVID like a lot of things. It’s affected the stamina of nurses caring for patients, even nurses that are like me and love it and don’t want to even think about doing anything else. I’ve seen nurses who are the best and I want to be like them and they motivate me to be better. The PTSD is real. After you’ve seen so much, it gets exhausting and then feeling like you don’t have the support and then being expected to work under conditions.

We’re in a pandemic, so you have to work with what you have but then you don’t get to use that excuse. If you fall short, you don’t get to use that excuse. We never get to use that excuse to not be able to do some aspect of our job or to have drinks at the nurse’s station, “We’re in the middle of a pandemic. You can’t have a drink at the nurse’s station.” That inequality or the inconsistency is wearing on some people. I worry about some but I do think that we’re resilient people. Ultimately, we’ll come out of it stronger and we’ll get through it. Getting through it has been difficult.

I’ve heard stories about that, it’s similar. Especially in those intensive care areas, it can be stressful and challenging for a lot of people who work in that environment. With that in mind, what kind of students would best flourish in this type of career?

For one thing, you have to have a good study plan. You cannot be the type of person who thinks, “I’m smart. I don’t have to study. I can pass tests without studying.” I know there are people out there that are like that and they don’t have to study. I’ve never met anyone who was able to get through nursing school with that attitude. Whatever you think you know, it’s different.

The best type of student is someone who has a good study plan. Click To Tweet

In nursing school, the exams are different. They give you these scenarios and you have to choose the best answer. A lot of times, all of the answers are correct and you have to pick the one that’s the most correct. The information that you have to know is not something that you might think you can figure out by using the process of elimination or whatever. Maybe that’s how you’ve been able to get through school.

If you’re not good at studying and you don’t have that commitment to take a huge portion of your personal time and devote it to studying, don’t even try it. I’ve seen too many people start nursing school and then not be able to do it because they’re like, “I have to have a personal life.” Nursing School is difficult and it’s going to prepare you to be a good nurse.

Let’s shift away from this. Let’s do my rapid-fire questions, if you will. Are you ready?

I’m ready.

What’s your favorite cartoon as a child?

HCDM 60 | Intensive Care Unit

Intensive Care Unit: The nice thing about working 12-hour shifts for nurses is that we typically only work three days a week.

 

I don’t know about cartoons because I can’t remember watching cartoons. I remember loving Sesame Street. I love that and Mr. Rogers. I would say Mr. Rogers more than Sesame Street.

If you could have any superpower, what would it be?

It would probably be to make myself invisible whenever I want to. If you make a mistake, all of a sudden, you can’t see me. I’m gone.

Favorite day of the week?

It’s probably Friday. I know that’s probably cliché. I love Fridays.

Fridays are good.

Even if I’m working, I love them.

There’s something about it. What game are you good at?

I like Trivial Pursuit. I’m not a sports kind of person.

That’s okay.

I love any trivia stuff.

Favorite comedian?

Brian Regan.

Your least favorite subject in school and why?

In high school or college?

Any.

I did not like the pediatric part of nursing school. It felt different from everything else. I’m an adult nurse, for sure.

Finally, what do you feel most proud about?

I’m most proud of my family, my husband, and my children. The way that we’ve raised our children to be good, caring, and kind people, that’s probably what I’m most proud of.

Tina, where can readers go to reach you? Where can they learn more about you if they want to?

You can go to the GoodNurseBadNurse.com website. Our episodes are on there, and other information. You can email me at Tina@GoodNurseBadNurse.com if you have any questions. We’re on Instagram probably more than any of the other social media, @GoodNurseBadNurse. We’re also on Facebook and Twitter, @GNBNPodcast.

You have a podcast, and that’s how I found you. It’s called Good Nurse Bad Nurse. It talks about day-to-day life as a nurse and what it’s like. You have some stories there, of course. You have guests as well every single episode or is it just you?

Every episode, there is always another host with me. A lot of times, they’re nurses but also other healthcare professionals. Together, we tell stories. We tell a true crime story first. It’s what we call the bad nurse story. It’s a healthcare professional that did something they shouldn’t have been doing. It could have been their personal life. There’s a lot of murder and mayhem in that one. We close out the show with something good that someone did or highlighting a historical figure in nursing or healthcare and not just nurses. All along through the conversation, we talk about nursing and healthcare in general. There’s a lot of that talk. It’s fun. I love it.

HCDM 60 | Intensive Care Unit

Intensive Care Unit: If you’re not good at studying and you don’t have that commitment to take a huge portion of your personal time and devote it to studying, just don’t even try starting nursing school.

 

It’s great for people who are nursing but also for people who are thinking about nursing. Would you say it’s also interesting to see a little bit of what life is like even in more detail?

Yes. It surprises me that there’s a lot of people who listen that aren’t even nurses. They’re like, “I love to listen.” They like the stories that we tell. Especially the true crime story, I do it in a way that has a little suspense. We put all the details in there. I put a lot of effort into that. They say it’s like getting a little window or getting to look behind the curtain and see what goes on in hospitals. If you are considering going to nursing school or you’re in nursing school, you should listen to it. Those people generally are like, “I love it.” I try to keep it positive as much as possible. There’s enough negativity. I don’t have to be one of those people.

Tina, it’s been great having you. I appreciate it. Thank you so much for coming to the show.

Thanks for having me.

That’s our show. Thanks for reading. To learn more about this episode’s guests or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. Of course, if you like what you learned in this podcast, please, go to my website. Add your name and email to my email list so that way you can get the latest announcements and news as they arise. You can also find me on Instagram, @DrRichardMarn. Thank you so much for reading, and catch you on the next episode.

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About Tina Vinsant

HCDM 60 | Intensive Care UnitI am a registered nurse with a BSN from Lincoln Memorial University in East Tennessee. I have been a nurse for six years. I worked for four and a half years on a Progressive Care Unit (PCU) at the region’s only level one trauma center.

On PCU, as a certified Progressive Critical Care Nurse, I worked as a team leader for over a year. Over a year ago, I moved to the Cardiovascular Intensive Care Unit (CVICU) and am now a certified Critical Care Registered Nurse. I am currently in a Master’s of Science in Nursing program with an emphasis in Care Coordination.