Rorye Proctor: Cardiac Intensive Care at Leeds Hospital
The Cardiac Intensive Care unit at Nuffield Hospital Leeds is what sets us apart from our competitors. The incredible team within the facility mean that we can offer highly complex surgery to the patients who come through our doors. Rorye Proctor talks to us about the unit, the team and how it works.
What is a CICU unit?
The CICU is abbreviated for Cardiac Intensive Care Unit - predominantly we undertake surgeries for patient requiring open heart surgery, including valves, coronary artery bypass. The patient demographic is NHS, Private and Insured, however we also support care for other patients who may be undergoing complex surgeries, or have multiple co-morbidities and require a higher level of observation or intervention following their surgery. These surgeries may include spinal, neuro, bariatric, reconstructive breast surgery following mastectomy, scoliosis, thoracic and those patients requiring higher observational beds that may not be available at the time of their surgery on the ward.
What level of critical care can you offer?
We can offer Level 3, Level 2 and Level 1 care within our unit, from fully ventilated patients requiring multiple drug infusions following their surgery to those who require monitoring that is more than a ward patient may require.
Why did you want to be a Critical Care nurse?
I had been qualified for a number of years before I decided that critical care was the area that I wanted to develop in, I had tried ward care, A&E for a number of years. I then applied and was successful for a position at Birmingham Children's Hospital which was a large hospital tertiary centre for cardiac services, transplantation, liver and renal services, and neonatal care amongst other services. I am dual trained Adult and Paediatric nurse and now hold relevant qualifications for both disciplines in intensive care, I have worked in National roles for Critical Care and Resuscitation. but the pull of being in a clinical team on a day to day basis was what was the most important to me and for my continued nursing career. Critical care nursing is incredibly rewarding as you see patients usually on one of the potentially worst days of their lives, to generally making a full recover if that is the expectation of their care pathway. As we monitor patients so closely, you can see the small changes and differences that we can respond to and see that we are helping patients improve in increments. It is this kind of reward, and feeling like you are making a difference which is appealing in critical care nursing. We deal with such a wide range of specialities from cardiothoracic surgery, to neurosurgery, to ear, nose and throat surgery and even through to plastics. No two days are the same, and no two patients are the same: different patients can respond very differently to the same surgery, and it is being a part of that patient's recovery and helping them get back to where they want to be that is so rewarding. This helps to promote better recovery and quicker healing times. The day may also involve taking patients to have interventions such as CT scans, X-Rays (or sometimes they come to the unit if a patient is too unwell to travel to the department). Even taking patients to the relatives' room for a change of scenery. Our days are very varied - and can change from one minute to the next.
If CICU is part of your hospital journey is this usually preplanned?
Yes, generally the bed on CICU is requested when the surgeon books the patient for their surgery, also when the patient is pre-assessed they may trigger a criteria that is met for a referral to CICU. This would then be discussed at our Patient Safety meeting and the Consultant and Anaesthetist would be informed. Cardiac patients are always booked for a CICU bed and their stay would be a minimum of two days as part of their care, however there are occasions when they may stay for a longer period dependent on their personal recovery. The day before their surgery when they are admitted to the ward they are seen by a nurse from CICU and told what will happen when they are admitted to us from theatre, noises that they may expect to hear such as alarms as they start to wake up. Importantly we also will contact their relatives once they are settled on the unit, and they are also left with a booklet of information. There are occasions when a bed may not be booked for the patient and it may be discussed with the CICU nurse in charge on the day of their surgery once either the Anaesthetist or Surgeon has reviewed the patient’s past medical history and deemed it necessary for thesafety of the patients care.
What’s the difference between ICU and CCU?
There is no difference, it is generally how the departments have been labelled. ICU or Intensive Care Units are generally known in the NHS to have a variety of different patients. CICU here will generally admit planned surgical cases, the patients may have been waiting on NHS lists, or are private patients, or even insured patients. They will have been pre-assessed for their admission to the unit, or risk assessed against their co-morbidities. We will occasionally also have readmissions to the unit if further support/care is required more than a ward level patient.
Why did you want to be a Critical Care nurse?
I had been qualified for a number of years before I decided that critical care was the area that I wanted to develop in, I had tried ward care, A&E for a number of years. I then applied and was successful for a position at Birmingham Children's Hospital which was a large hospital tertiary centre for cardiac services, transplantation, liver and renal services, and neonatal care amongst other services. I am dual trained Adult and Paediatric nurse and now hold relevant qualifications for both disciplines in intensive care, I have worked in National roles for Critical Care and Resuscitation. but the pull of being in a clinical team on a day to day basis was what was the most important to me and for my continued nursing career. Critical care nursing is incredibly rewarding as you see patients usually on one of the potentially worst days of their lives, to generally making a full recover if that is the expectation of their care pathway. As we monitor patients so closely, you can see the small changes and differences that we can respond to and see that we are helping patients improve incrementally. It is this kind of reward, and feeling like you are making a difference which is appealing in critical care nursing. We deal with such a wide range of specialities from cardiothoracic surgery, to neurosurgery, to ear, nose and throat surgery and even through to plastics. No two days are the same, and no two patients are the same: different patients can respond very differently to the same surgery, and it is being a part of that patient's recovery and helping them get back to where they want to be that is so rewarding.