The 6 Types of ICU Nurse
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THE WAR HORSE
You went to nursing school at a time when nurses still wore those funny, starchy white hats, back when sexual harassment and even physical abuse were expected hazards of the profession. You have seen more crazy shit than most people can expect to experience in several lifetimes … and you do not hesitate to let people, particularly new nurses, know it.
You’ve seen more dead bodies than a grizzled homicide detective, a county coroner, and all our active military combined. Your very first day on the job, a sundowning patient snatched the engagement ring right off your finger and swallowed it whole. You once caught a severely hypernatremic patient drinking urine from his own Foley bag. The last time you were the least bit fazed by a patient action, M.A.S.H. was still must-watch Sunday-night TV.
You see things in the pupillary response that even an experienced neurologist would miss. You can determine, merely from the color of a patient’s great toe, the precise extent of his hypoxemia. In a single hour of your shift, you can predict that a patient will crump, defuse a potentially explosive situation between bickering coworkers, educate a patient on colostomy hygiene, advise an endocrinologist on his choice of tube feeds, and still find time to hold the hand of an actively dying cancer patient.
God, your back hurts. You’ve been on “light duty” since 1957. Even the attendings are in awe of your vast body of nursing knowledge, and will cheerfully defer life-or-death decisions to your judgment. You don’t just deserve respect; you command it. You are, in summary, awesome.
And very cranky.
-Can locate a vein in parts of the human body that Superman’s X-Ray vision could not even detect
-Refers to attending physician by first name, and, occasionally, “Sweetie” or “Sonny”
-Has no discernible tolerance for small talk, clinical ineptitude, or hijinks of any kind
-Electronic charting a constant uphill struggle
-Probable latex allergy
Hey man, you’re just passing through. This isn’t your world. You’re only here for your requisite one year of ICU service, and then it’s hello, anesthesia school, and on to the BIG BUCKS. This is your movie; we’re all just extras in it. Get in, get out. That’s the ticket.
But while you’re here, you simply can’t resist “showing up” your coworkers with incessant talk of prolonged QT intervals, wedge pressures, and the efficacy of norepinephrine in an “alkaline environment.” While the rest of the unit is bathing patients, you are off in some corner, attempting to engage a disinterested respiratory therapist in a loving analysis of blood gas results, as if that were the most natural thing to do at four in the morning. You openly joust for the most complex, unstable patients — a proned, ballooned open heart on four pressors and CRRT who just tested positive for C. diff — that’s your bread and butter. You dream about that shit.
Despite your constant talk of leaving this place, you will find that on your last day — more so than any other nurse on this list — you will be saddest to leave, and may even openly weep on the ride home.
-Often drives a nicer car than the doctors
-Secretly has the cardiac arrest decision tree tattooed across back
-Will acquire and interpret your patient’s 12-lead, unprompted and unordered
-Perpetually studying for the CCRN
-Fanciful delusions of one day going to med school
-General insufferable douchiness
Oh, aren’t you adorable.
Look at you, with your makeup freshly applied, showing up to night shift all bright-eyed and bushy-tailed, bringing your preceptor coffee. You have a pep in your step that immediately betrays your status as a recent grad; you are like the power-walking embodiment of a shiny new RN license.
Your constant smile is infectious, and maddening. It may seem like your coworkers resent you, and indeed they might, but that’s only because you remind them of themselves, back when they had that bounce.
-Very useful in “code brown” situations
-Excellent folder of linens
-Room left clean and well-stocked
-Always down to help you bathe
-Rambling, virtually incoherent change-of-shift reports
-Utterly confounded by pulmonary artery catheters
-Unclear how or if boards were passed
THE LATE BLOOMER
Remember San Francisco? Remember working as an assistant to the VP of that sports marketing company? Remember your sparse, clean, but not-quite-upscale bungalow in the Outer Sunset? The one with the patio out back, where you had a little herb garden? Sure you do. You think about that herb garden a lot. All the time, really.
But something was always missing, wasn’t it? A vague, foreboding sense that you were wasting your life, that you weren’t doing “real work.” A nagging need to HELP PEOPLE; to be spiritually useful, somehow. This is what drew you to nursing, what called you to the field.
Still, you feel vaguely naked and vulnerable at work, as if having accidentally showed up to your old office job in your pajamas. Your scrubs still feel a bit like a Halloween costume, and perhaps always will. You can be seen most days wandering around the unit with a bag of labs in your hand, a look of confusion draped across your face, as if to say, “What do I do with these? Where do I go from here?”
And yet … something keeps bringing you back. Maybe it’s the lanyard you wear around your neck, the one that says REGISTERED NURSE in big red letters. Maybe it’s the serenity that results from doing work that is truly important, and doing it well. Maybe it’s that 60-year-old mother of four who you helped die with dignity, or coaching her family through what was likely the worst crisis of their lives. These small victories are very few and far between, but they always seem to come along at just the right moments, helping to push you along, at least for another few shifts.
-Lots of “interesting” stories about previous life in San Francisco, Austin, Seattle, etc.
-Stories are largely fabricated, if not outright untrue
-Is one nasty liquid bowel movement from getting in car, speeding out of parking garage, and driving off into the sunset, never to be seen or heard from again
THE ADRENALINE JUNKIE
Hear that sound? That rocking cacophony of blurting pumps and monitors? The screech of wheels against a checkered floor as the crash cart is rolled into a room? The sound of ribs snapping from that first crunch of chest compressions? You fucking love that sound. It’s the sound of doing battle with a soon-to-be-defanged Grim Reaper.
For you, this might as well be the sound of children playing in a sandbox. A full choir of heavenly angels, singing praises down onto the unit. You will waste no opportunity to insert yourself into any shit show or blood bath, so long as death is a realistic possibility. Double-lung transplant, fresh from the O.R., going into V-tach arrest? BRING IT. Cardiothoracic surgeons at the bedside, cracking open the chest? PARADISE.
-Considers CPR a “great triceps workout”
-Can subsist for weeks at a time on Sugar-Free Red Bull and Zebra Cakes from the vending machine
-Says things like: “I like to live on the edge” in job interviews
-Will attempt to cardiovert a walking, talking patient
-Runs a “code brown” like it’s a Code Red
THE TERRIFYING CRAZY PERSON
You, sir or madam, are deeply scary. No one really knows what you’re doing here, or where you came from, whether you’re part of some weird, covert government experiment. Years of working in a high-stress, high-volume profession have deformed you into a person indistinguishable from the rest of the human species. You have odd, unsettling hobbies outside of work — things like animal husbandry, or blogging about how the moon is a hologram projected into the sky by agents of the Illuminati. You are a poor historian, prone to trite, silly fabrications, like that you’re a third-degree blackbelt, or had stigmata as a child. You once claimed that you’d never consumed — or even heard of! — an avocado. You said this while dipping nachos into a big bowl of guacamole. No one dared refute you.
Strangely, you know your shit when it comes to patient care. Even the War Horse would concede this. All of which serves to make you that much more intimidating to newer nurses. You are not so much a bully as a monstrous, malevolent, all-knowing presence on the unit. People actually schedule their shifts so as to not coincide with yours. Your continued employment appears to be the result of you having something incriminating on the higher-ups at the hospital. Also, you have a near-encyclopedic knowledge of the methodologies of various serial killers, and you sometimes enjoy sneaking these dark factoids into your shift reports. You are bat-shit crazy. Even the unit director doesn’t dare cross you.
-A fertile wellspring of unit gossip and speculation into your private life
-Can be paired with annoying, unlikable new hire (or student nurse)
-Will eventually become a charge nurse
-Borderline personality disorder
-Shows up to work in Rudolph the Reindeer scrubs … in July
-Will eventually become a charge nurse
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