Critical Care Crisis Nurses

As an ICU fellow, my best friends are our critical care crisis nurses. Whenever we respond to a code blue, rapid response, or crisis on the floor, they are right there, handing us supplies, coordinating care, and reminding us of things we missed. Especially as we get to know each other better, we become a fluid team, anticipating each other's next suggestions, bouncing thoughts off each other. When I've arrived at a crisis, I find my critical care crisis nurse taking vitals, placing IVs, getting an EKG, sticking on defibrillator pads. While these seem like simple and obvious steps, I've been to a lot of codes before the crisis nurse has arrived and found everyone panicked and frozen. When you arrive to a room of strangers in chaos, it's hard to get control of the situation. You end up spending all your time and energy on delegating simple tasks like palpating a pulse, pulling up labs, or getting a crash cart. Our job becomes so much easier when the crisis nurse magically makes all that happen. Furthermore, they've seen so many clinical emergencies that they know what I will want. By the time I ask for a medication, they've already procured it from the pharmacist. They know the ACLS algorithms as well as I do. And they chime in to remind me of steps I've forgotten in the heat of the moment.

Perhaps most importantly, critical care crisis nurses also act as triage for the ICU. I'm not sure how they find out, but they know about many of the decompensating or unstable floor patients. I've gotten several "heads-up" calls from them, and their clinical judgement is sound. In the same token, they've also helped prevent unnecessary ICU admissions by investigating patients that seem unstable but have a rational explanation for what's going on. A common example is the oncology patient undergoing chemotherapy; occasionally, someone will call a rapid response for tachycardia, but this may be expected given their medications. Our crisis nurses educate and advise bedside nurses, charge nurses, and primary teams to avoid these instances. They are our eyes and ears of the hospital, and they make my job so much easier.