Announcer: [00:00:00] This is Nurses’ Voices.
Gail Donner: [00:00:04] We’re going to talk about critical care nursing with two nurses, but then going to tell us a little bit about what it’s like working in critical care, especially during this panel.
Announcer: [00:00:16] Nurses’ voices is supported by the Canadian Nurses Foundation and by the Canadian Nurses Association.
Gail Donner: [00:00:24] Welcome to Nurses’ Voices. I’m Gail, Donner,
Mary Wheeler: [00:00:28] and I’m Mary Wheeler.
Gail Donner: [00:00:29] Today. We’re going to talk about critical care nurses. And critical care nursing. And in this pandemic time, that’s been so difficult and there’s been so much pressure on critical care and on critical care nurses and nursing. We have two nurses to talk with tonight who are going to help us understand what it feels like, what is critical,care nursing, and what do critical care nurses do to maintain the quality of their care and the quality of their life?
Lisi Aldaba and Miriam Biju. Together have over 35 years of critical care nursing experience at the bedside. It’s pretty amazing. Don’t you think? So I think we’re gonna learn a lot of interesting things about what critical care has been like particularly now in the pandemic.
Lisi is a critical care. Registered nurse with 22 years of nursing experience experience. And currently she’s in the ICU at the Royal Columbia hospital in new Westminster, BC.
Miriam is also a critical care registered nurse at the bedside in Surrey Memorial hospital in Surrey, BC.. And Miriam has just under 26 years of critical care nursing experience. Maybe I’ll start with you Lisi. BC .
BC was doing so well during the pandemic and things were pretty well under control. And then I think none of us are sure what happened, but all of a sudden there was quite a big surge and a lot of pressure, I think on ICU and critical care nursing changed, uh, quite a bit from its pre pandemic.
So I’m wondering if you can start by telling what that was like for you?
Lisi Aldaba: [00:02:30] The first wave kind of hit and you’ve got this fear, fear of the unknown. Everything’s just, you know, you just don’t know what’s going on. We slide into sort of the second wave we’re comfortable. We’re good. We’ve got everything going you finally feel like you can take a breath and then just the world really just came crashing.
I think it just happened in the blink of an eye. All of a sudden, you know, your. Adjusting your capacities within your bed. You’re moving all of these patients elsewhere. You’re doing, you’re doing things that you would never have done, you know, pre COVID or anything else before.
I think the hardest part being somebody at the bedside is you see all of these changes and, you know, What has to give right now is substandard care.
And it sucks.
It’s, you know, you’re trying to just get through the 12 hours, you know, before you’re talking about stories where there was all the death and you know, how are we not doing this with families present and it’s FaceTime, but in this, it was, you’re seeing younger patients for one, which, when you see anybody closer to your own age, I think you’re just thrown off just that much more because you’re seeing healthy people, you know, with families that look just like my own at home. And it’s a whole new kind of fear than the fear that was there before. And I mean, at our hospital, we are the trauma centers.
So the sickest of the sickest of the COVID will come to us. So. Um, you know, all the other hospitals do, you know, do their thing, but there’s always going to be those few that just need something a little bit more, then they’ll come to us. But you’re also still getting all of the different traumas and you were a cardiac center as well.
So you get all of the cardiac people that go wrong. So you all of a sudden have an ICU that is imploding within itself. And I don’t even… there, isn’t really a word to describe it… and I can only imagine what it was like for Miriam at Surrey or for places at Abbotsford where long before we were in situations where we were calling it, you know, substandard care that we, you know, we’re very proud of. They were already doubling and tripling, you know, all of their patients long before we had to and I think it was just this eye-opening experience as to what was happening in what almost feels like this short amount of time. Now there’s all of a sudden, there’s a little bit of breathing room again.
Cause it was this time where everybody’s compressed and you’re doing all of this stuff. And I mean, God, we had patient like multiple patients in one room and I still can’t get over that. We had even done that. And again, like I say, you know, faces like Surrey and Abby were doing that long before we had to, but we’re also managing. You know, all the ECMO patients and things that come in. And so it was exhausting to say the least.
Miriam what was it like for you guys?
Miriam Biju: [00:05:48] I just had gone back to work after a year, uh, in 2020 and like March mid-March. I had to ask others about how the first few patients were because I wasn’t there. And, um, I, all I heard was, oh, the first patient was someone who was just anxious about their situation, that diagnosis.
So, um, that sounded. Okay. So this is, uh, uh, this is the first patient, and then it progressed from, I guess we just had one or two patients who had just simple from then on, we moved on to seeing patients on high flow oxygen.
Prior to COVID. We didn’t consider these patients to be as droplet when they are on opti flow or CPAP but then with the COVID we started having to put the PPE on with the 3M mask or the N 95. What are the procedures that are AGP, or the aerosol generating and what are not was always changing. Evolving. I have to say the first few, the first wave most patients were intubated fairly early. And then it felt like they needed prolonged ventilation.
So when the second wave came, they tried to not intubate them. So with the second wave gave us an opportunity to see a lot of people talking, telling us stories, telling how they got the COVID. I can’t believe if there wasn’t FaceTime, how people could have, could have, could have at least a few precious moments.
Or things that they could remember for their lifetime. And I remember this letter from this patient family, how it appreciated that you were there when we couldn’t be there. And those emotional letters meant a lot. I remember FaceTiming and family there for the teenage kids. The mom just managed to say I, and the L wasn’t clear enough.
And then you could figure out if she’s trying to say, I love you. And those are all very emotional moments, but on the other side, you are doing your job, right. You have to concentrate on numbers and, uh, waveforms, and you have to force people to stop talking and put on their face mask. Sometimes on a shift, you could have one admission, and you could have another admission, but to have like, once someone goes out at two o’clock, another one is already ready to come in. I just admire the way nurses went above and beyond. The craziest thing for me was these are not people who have been sick at home for a few days. Some of them are coming up from a COVID, um, testing center to the hospital.
I mean, some patients seem like they were coping really well. They were able to talk, they were able to eat, but you could see that their oxygen levels were going down. That was the weird thing about COVID. They could even talk sentences, but, um, their oxygen numbers were going down to the fifties and sixties and then came nurses thinking, well, we were like, are we doing the right thing?
Patients are not being intubated for such a long time. I mean, it is not a nurse’s call, but still watching patients suffering, breathing to breathe. It… nurses, started thinking, oh, is this the right thing? We leave them on the optiflow and the, or noninvasive ventilation for such a long time. By the time they are there, um, intrinsic abilities that have gone down, they are getting a little bit more sicker.
They are not, uh, will they make it, if they go on the ventilator. And unfortunately there came a time when we saw a lot of patients who went on the ventilator after prolonged non-invasive ventilation. That did not make it. They were, who knows what was the best. And third wave was shocking shocking from 26 capacity to going up to 58 or 60 patients.
Gail Donner: [00:09:54] So maybe this is a good time to go.. You, you expressed both of you really how much stress on families on the patients and on the nurses themselves, how the then with all this stress, both moral stress and even physical stress, I’m sure mental stress to get up every day or get up at night or whatever, and go in again and give so much of what it’s clear, both of you give to every patient.
Lisi Aldaba: [00:10:30] I have always prided myself in being able to find a career that I loved. This whole third wave it is a challenge just to get up, knowing that you’re going to go to work, to get in the shower, get in the car, and then you park underground and you’re like, what is it going to look like up there today?
And you know, it’s going to be such a disaster. And I know that I echo a lot of my colleagues. I think that’s what makes us human is that it’s been morally distressing. It’s stressful. It’s exhausting. It’s physically draining. It’s all of those adjectives really all sort of rolled into one. I think for myself, you know, the nice thing is I have a supportive family that understands one, what mom does for a living that I work in COVID hell every day.
So this is what I see. So they’re sensitive to that and they’re very supportive. Um, so they know that, you know, a closed door when mom’s sleeping posts nights, you don’t go in there. Um, so that’s kind of a nice thing, but I think with me and my colleagues, I think the only thing that’s getting us through this wave is us.
We’ve gotten really good at being able to read each other’s eyes. And you’re just able to know where everybody is. And it’s just been that mental strain of. You know, I think that’s the question is how do you keep going? We, you know, like Miriam had been in situations where, you know, you’ve sent you, a patient has just passed and before you’ve, as you’ve taken the room down, you’re already getting notice that you’re about to admit another patient.
So pre COVID time. You, you know, it was a nice thing, you know, you would have somebody pass nice and peacefully. You’d have family there. You’d be able to support them. You’d be able to hug them. You can all cry together or like give them what they needed and then set them on their way with a nice grief package.
Now it’s well, you know, have I shut the FaceTime off when I take this room down really quick? Um, and then you don’t get the time to have a break in between to recollect yourself because you had another patient that’s kind of come up and why, as I touched upon where’s the higher center to go to sort of in the region.
So in this last wave, I hope it’s the last wave, that we’ve seen. It’s been the sicker patients, the patients who were going to need the ECMO who need, you know, CRRT. So we have a lot of COVID baby nurses that have come out who aren’t full scope yet. Um, and so the weight falls on those that are full scope.
Cause now you’ve got to take on, you’ve just done this and you have to take on another patient. So it’s, you know, it’s exhausting, but I think the only way we’ve been able to sort of get through this is really. Through each other, right. I mean, as nurses and as nurses in critical care, we’re the only ones who really know what we’re going through because we’re all going through it together.
Mary Wheeler: [00:13:32] But so Miriam, what about
Miriam Biju: [00:13:34] for you? So I, I think what kept us going was everybody who had to put in at put in their best. I think everybody just, I, I can’t, I mean, nothing is a professional job. We are all we have all in one way or the other committed to doing it. I think there was that sense of, um, yes, I have to do my best.
I, I got to help in the situation. I’m in this profession where I can play a role. I, I feel like the world saw it. It was so encouraging to look outside our window, a writing saying: “this is where the heroes work”. Thank you. Uh, SMH, ICU, and every person, including the person who is cleaning. Who is stocking up, was giving us a food, trays the people who are calling the families, letters, all this helped.
I have to say my children helped. My family helped. My husband helped everybody helped because everybody talked about how stressful it was, but everybody kept going. I don’t know where all that energy came from. I think we all, as human beings have it in us. To just use it when we need it. We just come up to the need.
Gail Donner: [00:14:53] You two are amazing! I ha I have to say I’m sure there will be young nurses who are thinking, oh, that’s I didn’t know. It would be so difficult. I thought I’d like to be a critical care nurse, but maybe now I’m thinking twice about it. What would you say to those nurses who are thinking about a career.
Lisi Aldaba: [00:15:18] You know, I came from Emerg.
I spent six years in Emerg before I came out to critical care. Um, and a big part of it in that move is within myself. I know I’m a bit of an adrenaline junkie. I just love it. If something big is happening, if there’s a trauma that comes in, I mean, they’re like a dirty shirt. That’s my bag. Like, you know, I think that even through all of this, that’s going on.
I know, as soon as we’re sort of able to just kind of shake that dust off as to, you know, what we’re sort of feeling right now .At the end of the day. I think every critical care nurse will just kind of say, this is still what we want to do. Um, I think that being a critical care nurse, It takes a special type of person.
It takes a nurse that is, uh, marginally OCD. Um, but you know, just with the ability to want to, you know, put it all together. There’s a reason why we only have one patient because we can look at each and every detail that goes on with that person and give the absolute best care. And although now, With the way the world is at times, we know we feel we’re getting substandard care .
Things aren’t really the way that they are. I hope that our COVID nurse babies that have come, you know, we’ll be able to whip them into shape at the end of all of this and be like, okay, that’s, that’s actually not how it’s done. This is how we’re going to do it. This is what’s the best care we just did that to get by, you know, critical care is if you’re going to have other nurses listening to this, I might make myself in trouble, but critical care is the best!
Truth be told.
You know, when I left emerge, my goal was to find the compliment to emergency nursing that I knew that critical care was going to be. My goal was to stay the year that I had signed my contract for and come back to emerge. Uh, I mean, 16 years later, I’m still here. So that in and of itself has got to say something right.
It’s a place where we can be proud to be able to give. Um, the technical care that comes with knowing all the different, you know, vital signs and blood work and all the, that sort of business. But you’re also able to give that personal aspect. We shave all of our patients, right. Even, you know, someone’s going to be going end of life.
Then tomorrow we will wash their hair with like actual shampoo. It’s a full soap and body wash. You do all of those little things because you can, and I hope to get back to it soon.
Gail Donner: [00:17:52] But I can see that getting back to, why am I doing this is in itself a kind of help to traverse the bad times if you will.
Mary Wheeler: [00:18:05] I think in your story so far, for both of your stories, you are nurses who I want to have at the bedside, if I was in a need of critical care nurse. Um, but I, I think it’s important. What do you want to do? Here’s a great platform. What do you want to tell nurses, Miriam, about what keeps you doing critical care and what they should think about if considering this as a career
Miriam Biju: [00:18:34] You are in nursing because it’s your choice.
You have made a choice to care for people, and if you want to care for them, when they are sick, as sick as they can be. Then this is your place. You are, you. I have to say critical care nurse. Sometimes make me feel like they are born for this. They, they, there’s something in their genes that make them do what they are doing.
We will be in a career where every small assessment you make you feel like you are the one that is talking for that patient. If the patient is going to a GP and saying like, my abdomen hurts, this is where my pain is. This is where my swelling is. This is where my I can’t I feel numb, or this is the part of my body that, uh, you, if they are moving and they feel a chest pain, they can say it.
But when they are not able to say it, the nurse is the one. Yes. I found, uh, uh, ST elevation, I see that their heart rate is up. When they do this. I see that their heart rate is going down when their oxygenation is not adequate. They are more sensitive to this drug. They are not so sensitive to this drug. So it is, I am the patient sometimes.
Because I see it. I am the family member,
Mary Wheeler: [00:19:52] but I do love what you said. You said,
I
SEE
YOU……
Miriam Biju: [00:19:57] As critical care nurse. You are given the privilege. It’s a privilege to be a nurse for one patient. It is a privilege to help someone who is helpless. Nurses can do wonders. Nurses do wonder.
Gail Donner: [00:20:13] Well, all I can say is I wish we have lots more time.
Because there was lots that we could talk about and you clearly both have had such a rich experience, I’ll just add and close by by saying the very biggest, thank you. I’m so grateful for myself and having had this opportunity. It’s both of your genuine humanity for your colleagues, the public who’ve tried in their ways, the seven o’clock banging of the pots and pan the food.
And you didn’t talk about it, but clearly your families were very important to you in all of this, as well as your colleagues. So I thank you for being so open.
Mary Wheeler: [00:21:07] Gail, I have to say that was an awesome interview. And, and when I think about what nurses’ voices is all about, it’s really providing a platform for nurses to tell it what it’s like. at this moment in time, They represented nursing in its totality, but two different sides of the coin. So Lisi, when she talked about, and maybe it’s the setting she’s in, um, it’s um, you know, she said, you know, from emerge into this, uh, trauma center, Uh, the setting that she’s, uh, currently working in really distressed, sometimes that she wasn’t being able to provide the, the ultimate level of care that she generally would provide.
If she had one, one patient. So sh so that’s what I heard from her around the skill and the knowledge. And sometimes it was being compromised, but there was really nothing that they were trying to do their very best. Miriam brought another side of what nursing is about and really that human side. So she really spoke about that connection with the patient.
And I love when she talked about, you know, that. Uh, acronym, not intensive care unit, but I see you that I’m really, especially with COVID I’m, I’m your, your voice to other, uh, healthcare practitioners around. So what I loved about that is that. It was really two stories, but if you put them together, it’s like one half and the other half it is, it is that total picture of what nursing is no matter whether you’re in the intensive care unit, working with the homeless and other speakers.
So it was really interesting to see what they brought to this conversation.
Gail Donner: [00:22:56] I, I think I’d feel the same way you do. The only thing I’d probably add is. Um, they both in a very different way had such amazing passion for the work that they do. And I guess all I kept thinking was how they are so real. And I was hoping that nurses who are watching, who maybe are feeling a bit dispirited, these are very difficult times.
Uh, you know, the press is full of “oh nurses are leaving in droves” and you know, “so many nurses want to leave” that after COVID, we’re going to have problems, et cetera. And I just hope those nurses who were feeling maybe that they aren’t being heard. Uh, will listen to these, uh, nurses who, I mean, what they got experienced has been terrible, but they hadn’t lost the drive to carry on.
So that was one thing. The other thing that I have to say is I thought we’re calling this nurses stories. They would telling their story, thinking that you know, how they described, how they. With their patients. They’re actually trying to understand the patient’s story, so they can give the best care they can in whatever the circumstances are.
So, but I agree with you that it was a special, uh, reflection of what nursing is.
Mary Wheeler: [00:24:42] But that’s a nice connection back to our very first episode where the two Chantel’s talked about storytelling and how we really, you know, we need to be taught, not only telling our stories as nurses, but using that strategy, that intervention with, with our patients to tell.
To tell their story or to help them tell their story. They really were the spokeswomen for their, for their patients. The other two things that, um, especially with our work and careers, and I think Lucy brought it up is that you have to love what you do. And I think no matter who we have understood voices, what you’ll, we’re having public health nurses, we’re having.
Uh, you know, uh, nurses working in long-term care, what is evident and what we’re hearing, and maybe it’s just in the guests that we’ve chosen, but we’ve tried to be really, um, uh, intentional is that these individuals love what they’re doing. That, you know, that, that, that what comes across for me is that, and that’s what we say to people when we help them try and figure out their career, if you’re not happy, that’s okay.
But then to find a different place. But for these women, they have found a career that they love and that, and that even in the hard time, They what they also say. And what’s a theme that coming is coming out in these nurses. Voices is that there are these teams, it’s the people that you surround yourself with.
Um, we know that from the work that we do, but also for them, the way… who they surround themselves… is a make or break. Um, you want, and you know, it’s, it’s that, you know, it’s the, you know, something we’ve used in the past, the crabs and the dolphins surround yourself with dolphins and move away from the crabs.
And that’s what, you know, it, it, it’s maybe making light of it, but I I’m hearing that in all of these nurses, voices stories, the people that I surround myself with I’m, I’m passionate about what I’m doing because I’m working with a team of people that are passionate also.
Gail Donner: [00:26:58] And, you know, when, when, I mean it’s a while since I’ve looked, but when you, when I looked at the literature all about what nurses want, and that is one of the things that nurses have traditionally said contributes to them, being able to do their best work, right.
Is being surrounded by others who are. Want to do what they’re doing and do well, et cetera. So, yeah. Yeah,
Mary Wheeler: [00:27:24] no, this was great. It was great. And I’m looking forward to the next nurses’ voices.
Gail Donner: [00:27:30] Me too!
Thanks for joining us for this episode of Nurses’ Voices. We hope you’ll join us for the next episode.
And until then please go to nursesvoices.ca and give us some feedback and perhaps tell your story. We’ve already heard from several nurses. Who’ve both provided us with some good feedback and also told us a little bit about their practice and their nurses story. So please do that. Also nurses, voices is available also on YouTube ,it’s available as a podcast. So please use whatever platform you usually use and follow us on nurses’ voices.
Announcer: [00:28:15] Nurses’ Voices is created by donnerwheeler. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association. Nurses’ Voices is produced by Cecktor Limited. .
