Primary Care Nurse ICU: Interview with Tes Tayag, RN, MSN, CCRN

My Specialty

Primary Care Nurse ICU: Interview with Tes Tayag, RN, MSN, CCRN

Mentoring new nurses while providing clinically competent bedside care

By Keith Carlson, RN, BSN, CPC, NC-BC
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Tes Tayag, RN, MSN, CCRN  
St. Francis Medical Center  
Lynwood, Calif.     

Please share with us the history of your nursing career.   
I earned my bachelor’s degree in nursing at the University of the East in the Philippines and my master’s degree in nursing in California. I’ve been a nurse for 38 years, 34 of which have been in critical care right here at St. Francis Medical Center. I’ve had my CCRN [adult critical care nursing] credential for 32 years. I’m getting ready for retirement in 13 months. My nursing career has been wonderful.

What inspired you to pursue a career in the ICU and critical care?
I began working as a nurse in the U.S. on a med/surg unit at Saint Mary of Nazareth Hospital Center in Illinois. After one year, they moved me to critical care and provided on-the-job training and orientation. That began my journey in critical care and the ICU.

What was it like to make that transition as a relatively new nurse?
It was nerve-wracking; everything that happened to my patients made me nervous. Being from another country, the language barrier was my main problem and answering the telephone was a challenge. I took English classes and I had a preceptor who took me under her wing with incredible compassion. We stayed in touch until she passed away. I will always remember her kindness.

Clinically, what was most challenging in your first few years in the ICU?
My greatest challenge was enhancing my critical care skills. Nursing practice was very different in the Philippines; there, medical interns and residents did most of the critical thinking and the nurses simply took orders and carried out tasks. American nursing emphasizes critical thinking — you identify a problem and do something about it right then and there. That motivated me to sharpen my skills and learn continuously.

What populations have you worked with in critical care?

Here at St. Francis, we serve a largely Hispanic and African-American adult population. We deal with a large number of young adult trauma patients as well as many geriatric patients, since we’re surrounded by nursing homes. As a trauma facility, we see a great number of gunshot wounds, stabbing victims and motor vehicle accidents.

Have you ever worked with pediatric trauma cases?
I’ve worked with few pediatric cases in the emergency room, since all trained, experienced ICU nurses at St. Francis respond to traumas in the ER as support for the emergency room nursing team. St. Francis doesn’t have a pediatric ICU, so pediatric trauma cases are triaged and transported to appropriate nearby pediatric receiving facilities.

How are trauma cases handled at St. Francis?
Critical care nurses who are assigned to trauma response for a particular shift only have one ICU patient during that shift. These nurses are encouraged to have their TNCC [trauma nurses core courses] certification and must have undergone trauma orientation.

As soon as a trauma case has been called via the EMS, the ICU nurses assigned to the trauma team respond immediately to the ER. The ER nurses are primary in these cases and we critical care nurses provide secondary support. Our specific jobs include starting large-bore IVs; taking vitals; and assisting with foley catheter insertion, blood transfusions and intubation. The ER nurses make sure that everyone is gloved, gowned and in compliance with regulations.

When the trauma patient comes through the door from the ambulance bay, I am prepared to start an IV. I also assist in blood transfusion by being proficient in the use of Level I machines, which are capable of transfusing one unit of blood in 15 minutes during massive blood transfusion procedures.

Do you currently have managerial or charge responsibilities in the ICU?
I was a charge nurse years ago, but right now, I’m very happy doing bedside care, since that is where I find my greatest job satisfaction. Charge positions are stressful and I eventually decided that providing direct care to patients was where I could feel most useful and professionally fulfilled.

At St. Francis, we have a clinical ladder with four levels; I’m at Level 4. At that level, you assume more clinical responsibility and are also financially compensated for achieving that degree of clinical expertise and training. To reach Level 4, you must have a master’s degree, be board-certified in your area of expertise and actively participate in staff education, along with many other requirements. You must also be active in the preceptor program for new hires and nursing students.

How would you describe your level of job satisfaction?
I’m a nurse who really loves my job. One of the most satisfying things for me is when I receive thank-you letters from patients expressing how I cared for them or how I changed their lives.

We have a program at St. Francis called “Superstar.” Patients write their comments on commendation cards, which are sent to the human resources department or the unit managers. I receive many of those cards from my patients and their families. It makes me feel so good about my work.

The nursing students I work with also make me happy. On a daily basis, I have a student assigned to me and I’m given the opportunity to guide and train them, giving them their first experience of many clinical skills. When we do a recap of their day, I ask students to reflect on what they have learned. When they talk about feeling inspired by me, I know that I’ve motivated future nurses who will carry on my dedication to excellent patient care. I feel blessed by my work.

For new nurses interested in critical care, what do you recommend?
New nurses interested in critical care should pursue their ACLS [advanced cardiovascular life support certification] as well as basic and advanced training in ECG interpretation. They should begin in med/surg and work their way up the clinical ladder as they master more skills.

New nurses training in critical care should never give up. It’s a stressful environment and it is imperative that you remain focused on the positive. New nurses need to learn from every experience, take class after class and continue to look forward.

Sometimes stress makes it hard to keep a positive attitude, especially when a patient dies. Emotions are high, and people want to place blame. I tell my students not to let this get them down.

Can med/surg nurses move up into critical care?
For the longest time, we did not accept med/surg nurses into the St. Francis ICU, but I convinced the administration that we needed to train our nurses for critical care. My reasoning was that we need to give our nurses an opportunity to learn those advanced clinical skills.It makes more sense to promote nurses from within the St. Francis family than to hire from the outside. Nurses already loyal to the facility will be even more devoted to quality care, especially if we believe in them enough to give them a chance. Since I requested this program, we’ve trained five med/surg nurses to advance into the ICU. The success rate has been very high.

Most of these nurses apply for positions in the ICU after meeting the basic requirements, which include ACLS and a basic critical care course. When accepted, nurses receive six to eight weeks of intensive training with an experienced preceptor, developing increased proficiency in many skills along the way. All preceptors must meet certain qualifications, including attending preceptor classes to learn how to teach in a motivational manner and present new knowledge and skills in ways that are not overwhelming or intimidating. I’m proud to have initiated this very successful program at St. Francis.

How do you take care of yourself?
I pray a lot. Before I come to work and during stressful times, I say a short prayer, which truly relieves my stress. I attend church regularly; as an evangelical Christian, my faith community and church are very important to me. I also relieve stress at work by looking at photos of my dog throughout the day. When I finish my work day, I come home and walk my dog, do arts and crafts, listen to music and attend Zumba classes. Every month, I also volunteer to feed the homeless as part of the St. Vincent de Paul Society’s homeless outreach program.

What really keeps you going and motivates you?
I’m very inspired by the mission statement of St. Francis. I live by those words. My hope is to inspire young nurses to be good nurses. Nursing is not just about money; it’s an act of service in itself. If you really take nursing to heart, you have the chance to inspire people every day of your life.   

Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

This article is from workingnurse.com.

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