ICU Nurse / NP

The journey of a nurse’s career can be filled with twists and turns.   Ask Barbara C Philips, nurse practitioner and ICU nurse.  Barbara found her windy nursing road from med-surg, to ICU, to an advanced nursing role as a Nurse Practitioner.

The moral of Barbara’s story is clear, be hungry for knowledge, success and growth.   Barbara seemed to rarely turn down  an opportunity to advance her career, knowledge and skillsets as a nurse.   The result of her hard work and dedication is a vast amount of experience and honed ability in the field of nursing.  Something that is no doubt priceless to her success in her career and to her growth as an individual.

Read on to understand more about Barbara’s career path in becoming an ICU nurse and  finally moving into her current role as an NP.

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How did you first get into the ICU department?

I have always wanted to go into ICU, but I started in med-surg and then telemetry. When my hospital offered a course and I jumped chance. I had been with the hospital for a few years and had excellent reviews. That initial program was 6 weeks, M-F with increasing clinical time. Once we graduated from the course, we were precepted on the unit.

Can you tell us a bit about your career as an ICU nurse?

I started out in a medical surgical ICU, learning all I could and eventually become credentialed in critical care (CCRN). Over the next 15 years, I worked in every critical care area available to me including burns, neuro, trauma, cardiac, surgical, and the emergency room. I worked in major hospitals both on staff and through an agency.

What was the greatest attribute you gained while working as an ICU nurse?

I think the biggest gift that I received from work in an ICU was the development of my assessment skills. I learned to make quick and thorough assessments, and quick decisions. This one skill was invaluable and has been utilized throughout my career as a nurse practitioner.

What was the most challenging aspect of working in the ICU?

In the beginning it was the sheer volume of knowledge and skills that I needed to master. Later it became the sheer amount of trauma and illness an individual can go through. Sometimes results are disastrous. Being able to be supportive to patients, families and one another is essential.

What attributes should someone have to be an amazing ICU nurse?

Confidence, amazing assessment skills, the ability to make decisions, intelligencet, a sense of humor, being grounded in reality, someone who can take care of themselves. You’ve got to be a negotiator, a mediator, and at times have big shoulders. Something I had to learn early on was to be flexible…your patients have their own agenda, and do not follow your plans and schedules for the shift.

If a nurse was looking to get into the ICU, what are some of the best ways to get his or her foot in the door?

First and above all, perfect your med-surg skills. Take all the continuing education you can find on topics pertinent to critical care. Apply for internship or residency programs in critical care. Be willing to work the odd shifts.

Can you tell us about one of your most difficult cases, something that was challenging but also inspired personal growth?

Years ago when bone marrow transplants were still rather new, I was one of a handful of nurses who had the knowledge and skills to care for these particular patients.

I was privileged to get to know one particular patient and his family as he was admitted and discharged from our unit several times over a matter of months. He was suffering from graft versus host disease as a result of his BMT. During one of those visits, in the middle of the night, with his wife present, he spoke about what would happen if he did not survive. He also spoke about end of life and had wanted to spare everyone the agony of making choices.

One afternoon, after a week off of work, I found his family waiting for me as I exited the elevator. He was not doing well and had been waiting for me to return to work. He asked if I would be his nurse again.

After getting my assignment, I went in to see him and it was obvious that his time was near. His platelets were in the basement and he was slowly “bleeding out”. I spoke with him and his family at length. It was clear that he and his family were relieved that I would listen and take action. I left to call his physician and advocate for him and his family for the discontinuation of all treatment and allow him to die in comfort.

He died the following day in the beginning of my shift. While I was sad (yes, the tears flowed), I felt honored to be able to advocate for him and his lovely family.

Critical care is not just about the lives we save. Sometimes, the “critical care” we give is supporting out patients and families in their decision to die.

At what point did you decide to become a nurse practitioner? And why did you choose that career path? Has it been the right move?

Initially, I became a nurse practitioner quite by accident. I had essentially burned out after 15 years in critical care. I wanted to do something different. A friend had asked me to come to some nursing homes she managed and teach assessment skills to nurses. While there, I met a woman who was not only a state surveyor but also faculty at a Geriatric Nurse Practitioner certificate program, She recruited me on the spot. I attended the program (it was the last of the certificate programs) and it fit me like a glove.

My experience as a CCRN set me up to manage complex geriatric patients. Everything I learned was built upon what I learned in ICU. It was an excellent foundation.

I later went back for yet another program, this time to earn a masters degree as a Family Nurse Practitioner. Once again, my ICU foundation as critical in my success.

Do you have any final words for nursing students looking to become ICU nurses?

Do as much clinical as a student as possible. Master anatomy and physiology and assessment skills. You will call upon those things daily and they will be the foundation of what you will learn in critical care. While some hospitals will consider new grads, most want some experience. Get the best experience you can, and if available apply for a residency program.

ICU can be a career in and of itself, or it can be an excellent foundation for advanced practice. I have always been grateful for the amazing journey I had in critical care.