March 23, 2022

From theatre to ICU: Nursing secondment

When the second wave of COVID-19 took hold in Victoria in late 2020, theatre nurse, Ruby Dadd, pivoted to work in our ICU temporarily to assist her colleagues amid increasing cases. Ruby says she was initially anxious, however, thought it would be an amazing learning opportunity, and would allow her to obtain a new set of clinical skills.

When another wave hit in late 2021, Ruby was happy to return once again to our ICU and play her part in caring for critically ill COVID-19 patients.

We recently spoke with Ruby to find out how she made the most out of her secondment. Ruby was also recently featured in the Australian Nursing & Midwifery Journal – read her story here. 

How long have you been a theatre nurse for?

I have been a theatre nurse for five years, having completed a Postgraduate Certificate in clinical nursing, specialising in anaesthetics. Prior to my secondment to ICU, I  was working at Northern Hospital’s general operating theatres as a Clinical Nurse Specialist and Clinical Support Nurse, specialising in both anaesthetics and recovery nursing.

Did you have to undertake any additional training to work in ICU?

In 2020, I completed the SURGE High Dependency and Critical Care online rapid upskilling courses. When first starting my redeployment into ICU, I had supernumery shifts with Critical Care Registered Nurses (CCRNs) who demonstrated how to structure a shift in ICU and went over some of the clinical skills that would be used frequently.

Once starting to take patients independently, a model was set up by ICU so that there were a few CCRNs floating each shift as resources for the redeployed staff, providing some extra support when completing tasks or faced with new situations.

Take us through a typical day working in ICU on the frontline amid the COVID-19 pandemic.

I am caring for ICU patients independently, often looking after COVID-19 positive patients. These patients require varying levels of advanced life support, many of which are on some form of invasive ventilation, often intubated or with a tracheostomy. Some patients are requiring full ventilator assistance, while others we are assisting to wean off a ventilator so they can go on to breathe independently again when recovering from COVID-19. This involves constant assessment and treatment of a patient’s sedation and haemodynamics, often titrating numerous infusions and oxygen levels to accomplish safe target ranges for each individual.

Throughout each shift, I am working closely with the intensivists and ICU registrars to continuously re-evaluate and manage critically ill patients through a variety of tests, procedures and assessments.

COVID-19 has changed the way in which we function as nurses, from the full PPE required during treatment of patients in high-risk zones, daily self-swabs, social distancing and the exhaustion that comes with all of these factors. Communication has become more arduous with masks and face visors preventing the exchange of a smile or the ability to read a person’s lips, while plastic gowns can make working shifts very uncomfortable and tiring. Reduction in the numbers allowed in tea rooms means that catching up with colleagues, getting to debrief or provide another co-worker some support has become difficult. I am grateful to be surrounded by some amazing nurses who reach out through other methods to check-in, give encouragement and offer support.

What synergies and differences have you discovered between the operating theatre and ICU? 

We do care for ICU patients in theatre, and provide care for them immediately post-operatively in the recovery room. We also frequently assist with intubations and are around ventilators, as well as assist with the insertion of invasive devices such as arterial and central venous lines. However, in theatre, the nurse does not have the sole responsibility for the management of these devices, as an anaesthetic nurse is working alongside and assisting an anaesthetist throughout a case, and patients are extubated prior to coming out to the Post Anaesthesia Care Unit (PACU) nurse. On the other hand, an ICU nurse is required to manage a patient who remains intubated, and regularly access invasive devices, throughout a shift. There is a lot more autonomy for the ICU nurse, and more responsibility placed on them in regards to ensuring a patient is being ventilated safely and appropriately.

I am grateful that some of the ICU nurses were so kind and understanding about how overwhelming it is to start out in a completely new environment. They made me feel like I could reach out for support during my shifts if needed.

What have you learned most about yourself from this experience so far, both professionally and personally?

I think, throughout my redeployment, I have learned not to doubt myself. It is completely normal to feel anxious when faced with change and unknown circumstances, and I have proven to myself that I have the resilience to deal with difficult situations, adapt and take on a huge change. Professionally, I have learnt that I have the capacity to apply myself and my clinical knowledge and challenge myself to develop the skills required to work effectively in a highly critical clinical environment.

I am proud of myself for having played a significant part in the fight against COVID-19, supporting my hard-working colleagues and helping numerous patients to recover from life-threatening situations.

What advice would you give an early career nurse about the benefits of secondment?

Secondment is a really great way to experience a clinical area that is new to you and is a fantastic learning opportunity. It allows you to gain valuable skills that will carry over into other areas of nursing and can be applied to your chosen area. In particular, with a secondment into ICU, there are so many amazing learning opportunities to be taken back to your area of nursing, such as managing clinical deterioration and being involved in the use, insertion and management of a variety of invasive lines and airway devices. It is also a fantastic way to establish hospital-wide connections which may assist with your career progression.

How do you hope to use the skills and development you have gained from this secondment to shape your next chapter in nursing in the operating theatre?

I have a much greater understanding of ventilator settings, which I will be able to relate to cases in the operating room and hope to pass on a more in-depth level of knowledge about mechanical ventilation to the future anaesthetic nurses of Northern Health through my Clinical Support Nurse role. I also hope to be able to identify and deal with clinical deterioration more efficiently, and utilise all of the clinical knowledge and skills I have gained, to provide optimum care for my patients while in the anaesthetic or recovery nurse role.

Although overwhelming and exhausting at times, I have enjoyed the experience and am grateful to have gained a multitude of skills that I will carry with me for the entirety of my nursing career.