Rodelio Bayas, RN; Relief Charge Nurse
Good Samaritan Hospital, Los Angeles

Can you describe your career history as a nurse?
I came to California in 1995, became an LVN, and then earned my RN. My nursing work included med-surg, orthopedic and oncology until a manager encouraged me to become an ICU nurse. Now I float to CCU, ICU and telemetry.

What do you love about critical care nursing?
I love working with the heart. In critical care, most patients have different kinds of cardiac problems. Telemetry and critical care involve a really good team effort, from the people looking at the monitors to the secretary that supports the team. Every time I go to our unit, I am willing to serve. For many patient and families, sharing their fears and anxieties is the most difficult thing. Being aware helps me to develop a care plan that is unique to that patient, because every patient is unique.

What special certifications or trainings are needed to become a critical care nurse?
ACLS and ECG interpretation are most important. Many hospitals offer career advancement and tuition reimbursement so you can pursue CCRN and other certifications, but not every facility requires it.

Bearing in mind HIPAA regulations, is there a story or anecdote about a patient that you would like to share?
Serving my patients makes me a better person, and there is one patient that represents a cornerstone of my work here. This patient was a cardiac patient, and when I met him, we began talking about politics, current events and sports since I knew that he was interested in those things. After that, we were able to explore his fears and anxieties. Even though he passed away, I was able to connect deeply with him as a nurse and as a friend.

Do you have any advice for nurses who might want to explore critical care nursing as a potential career track?
I recommend that they go back and explore why it is they like to be a nurse. It’s a great career, but the most important thing to know is why we are helping these patients. Are we here to just work our shift or to let patients know that we are here to lend a helping hand and be there for them when they need us? Also, don’t be stagnant. Keep learning new things. Some of the old ways may be fine, but keep pursuing knowledge. This is a great tool for your advancement.

Sherbene Casilla, RN, Critical Care Manager
Glendale Memorial Hospital, Glendale, CA

Can you tell us about your workplace?
Glendale Memorial Hospital is known as one of the top 50 hospitals in the nation, and one of the leading heart centers in California. Our physicians are very responsive to research-based practice and new therapies, and we have one of the most advanced electrophysiology programs in the area. I moved to LA in 1999 and started here at Glendale Memorial in 2000, and I never looked back.

I began in a step-down unit, and a year later my manager offered me the challenge of a critical care class. The critical care class was didactic in nature, involving six weeks of intensive education covering every system of the body. Not long after, I was moved to the ICU where I trained on open heart patients, shadowing and working with a preceptor until I got comfortable.

What do you love about critical care nursing? What keeps you coming back to work? What feeds your spirit?
The dynamics here change all the time. My interest has always been cardiology, so it’s a good fit. I constantly seek to know more, how all the tests and meds tie into treating the disease process. I work with a great group of nurses — we’re like a team, a family, and we support each other. No matter how hectic and difficult, there’s someone who has your back. Some nurses stay here for decades.

How has technology changed in critical care?
As far as technology is concerned, new protocols for therapeutic hypothermia is one example of how things have changed. Studies have shown that this preserves brain function after cardiac arrest, and we’ve had success with that. We have also implemented a protocol for treating sepsis. We are trying to bring these things here so that we can be an ICU that keeps pace with emerging research and technology.

There have been advancements in interventions to treat coronary artery disease such as drug-eluting stents, and laser procedures to break up clots. They also used to open your chest to treat an aortic aneurysm, but these days it’s an endoscopic procedure via the groin, with a threaded catheter and mesh placement around the aneurysm. This is less invasive and poses fewer risks to the patient.

Of course, we also transitioned from paper to computer charting, and that was a huge shift. Some nurses are still trying to get used to it. My mother, who was a nurse in Canada, took an early retirement when her hospital switched to electronic medical records! Computers do make our lives easier in some ways, but the nurses often feel like they’re treating a second patient — the computer. That said, we try to stay focused on the patient and their family, delivering compassionate high-quality care despite spending so much time on the computer.

What special certifications or trainings are needed to become a critical care nurse?
CPR and ACLS are the bare minimum, as well as ECG certification. Critical care nurses also need to attend and pass a critical care course with a clinical component. Intra-aortic balloon pump training also helps, but can be pursued after beginning employment. I recently hired a nurse who worked in telemetry and showed a lot of promise, so I’m sending her to the critical care course now. Telemetry is excellent training for critical care.

Bearing in mind HIPAA, is there a story about a patient that you would like to share?
We recently had a very sick patient who collapsed at work and was rushed to the ED with what turned out to be a very serious infection. The patient had sepsis, the BP was bottoming out, and there was one nurse assigned just to that patient alone. We were all in there helping the nurse hang blood and fluids, take vitals, and give all the medications that the patient needed. The anesthesiologist was sitting in the room constantly writing orders. He ran to the OR when needed, and then would come back to the bedside.

After a few days, we didn’t think the patient would make it, but we did our job well and we just received a note from the patient that they are home and doing fine. This was a testament to teamwork and the frequently positive outcomes that we achieve. Sometimes it’s a thankless job, and while we’re not looking for fireworks and flowers, a simple thank you note from someone we poured our hearts and souls into caring for can really make our day.

Do you have any advice for nurses who might want to explore critical care nursing?
I recommend taking an ECG class, getting familiar with cardiac physiology, and getting experience on a telemetry floor. In a year, if you’re comfortable with time management, patient care and organizational skills, then apply for a critical care position.
Critical care is a very challenging environment and can be stressful, intimidating, and, frankly, scary. Prioritizing is critical, and your assessment skills have to be sharp.    

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Keith Carlson, RN, BSN, is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is editorial contributor to www.BlackDoctor.org. His own blog can be found at www.digitaldoorway.blogspot.com.