The Intensive Art

Well, my ICU interview is tomorrow. I’m experiencing a strange combination of excitement and anxiety–with just a touch of sadness at the prospect of leaving my current position. I figured that, as practice, I would choose a few probable interview questions that I may be asked tomorrow and type them up meme style. These questions are a combination of questions that I know for a fact they will ask me (based on word of mouth), typical interview questions we’ve all heard, and some that I found by googling, “ICU nursing interview questions.” They probably won’t match the questions exactly (or perhaps at all), but this exercise will hopefully get my mind into interview mode.

1. Tell me about yourself?

I finished my Bachelors of Nursing degree at the University of ******** in December of 2006. Prior to earning my degree in nursing, I struggled to find my passion, so I took many different courses. I was particularly attracted to Philosophy, Sociology, Psychology, English, and Art History. What I discovered is that Nursing gives you the chance to learn, study, and experience all disciplines of social science and humanities.

Prior to graduating I worked as a nursing attendant on a very acute, general surgery/surgical oncology unit. Once qualified, I trained as an undergraduate nurse on the same unit. Following graduation, as a graduate/registered nurse, I decided to remain on that unit as I felt it offered the absolute best potential for personal growth and learning.

For the past five months, I have been working on gaining a certificate in critical care nursing from the local college. While the lessons I am learning from this coursework are beneficial to my current practice, I feel I’m ready to take the next step and train as an ICU nurse.

2. Why did you become a nurse?

It really was a combination of many factors. I think the first time I ever thought to myself, “nursing would be great!” is when I was a little kid. My Grandmother was a nurse, and I was fascinated by the fact that she was allowed to stay up all night to work. But, I also loved browsing her bookshelf of nursing textbooks. I would stay up long past bedtime reading about nursing procedures and anatomy.

I continued to be very drawn to biological sciences. When I was about 23 or 24 years old, when I realized I had to choose a career, I knew it would be something medical. I researched everything from x-ray technician to lab tech. I even thought I could work hard an maybe go to medical school.

However, my mind kept going back to nursing. As I mentioned before, I discovered that nursing allowed me to implement knowledge from many fields. It wouldn’t be just biology I would be learning, but also social sciences and humanities. It also offered shift work–which I prefer, a vast array of specialties, and job security. It offered a balance between technical skill, science, intellectualism, and human connection.

3. Why do you want to work in the ICU?

That’s an interesting story! When I started my nursing degree, I had absolutely no thoughts of working in the ICU. Not because I didn’t necessarily want to be an ICU nurse, but because all I wanted in life was to be an ER nurse. For every optional buddy shift I went to the ER, I watched ER reality TV shows obsessively, I dreamed and visualized myself as an ER nurse.

Then I read Tilda Shalof’s book, “A Nurse’s Story: Life, Death, and Inbetween in an Intensive Care Unit.” When I read this book I felt an entire shift in the way I felt about nursing. I began to gain an understanding of nursing as a more holistic practice. It wasn’t all about adrenaline and trauma: it was about seeing the patient as a person both in detail and in the big picture. Nursing is about ethics, and families, and communication–just as much as it’s about being able to do complex dressing changes.

After reading Shalof’s description of an ICU, I was absolutely hooked on the idea of being an ICU nurse. I didn’t entirely let go of my thoughts of being an ER nurse, but I started researching further into ICU nursing.

I loved the small nurse:patient ratio allowing me to focus more on a patient’s care, I loved the potential to work with families more thoroughly, I loved the team environment, and the better relationships between nurses and doctors/other practitioners. More than anything, I loved the idea of taking care of extremely complex patients that would allow me to push the envelope of my own skills and knowledge.

4. What certifications do you have?

I’m certified in CPR with plans to take my ACLS in March, I am currently working on my critical care certificate–I am on course 2 of 5. I am certified in central line care–level 2 (which means I can take them out. Level three means you can put PICCS in), patient controlled analgesia and patient controlled epidural analgesia, total parental nutrition, and VAC dressings.

5. What is the sickest patient you have ever cared for?

As I work on a very acute surgical unit, the typical sickest patient is either in septic or hypovolemic shock. The sickest patient I ever cared for was on a night shift. He was planning to go home in the morning as he had completely recovered from his bowel resection surgery. However, during the evening shift he started feeling nauseous and his abdomen became distended. I didn’t meet him until just after I started my shift when he was coming back from a CT scan. I took one look at him and called for help: he was grey and gasping for air.

Over the next several hours his condition deteriorated. He was in complete septic shock. We worked on him for hours, trying to maintain his volumes, and keep his blood pressure up, started IVs, drawing blood work. When I put a foley in, I got one drop return…one single drop!

The entire time, the patient was calm and even witty, but his wife was terrified. She just kept saying, “please…all I want is one more month with my husband…please.” I will never forget her.

The CT showed that his anastomosis site had blown and he was leaking contents into his peritoneum. He was getting sicker and sicker before our eyes. The surgeons whisked him down to the OR but it was too late and he eventually passed away.

Fortunately, before he passed away, we were able to set up a private room for him and his family. We brought in comfortable chairs. As he died, I answered questions for the family. They wanted to know how we would know when he had passed away for example. We left the family alone with the patient for about an hour after he died.

I will never forget that night.

The sickest stable patients we take care of are liver resections. We generally have four or five IVs running continually. They struggle with electrolytes, so we are always trying to balance their IV meds based on blood work. Plus, it’s a very large surgery and can have many complications. These patients are always in our high observation room.

We also care for intraperitoneal chemotherapy patients. They have three JP drains and a Tenkoff drain. Every day we fill their abdomen with warmed chemo and then drain it 24 hours later. This surgery is generally about 10-16 hours long and includes manipulation, resection, and stripping of many organs. These patients are very acute, and generally experience many set-backs–both medically and emotionally.

6. What are your strengths?

I think my strengths are: Organization and time management, interpersonal communication, positive attitude, great team member, leadership skills, teaching, learning,

7. What are your weaknesses?

I can be too focused on details at times and miss the big picture. Through reflection, I decided that this is the the component of nursing that I want to work on the most this year.

As part of my continuing learning required for my license, I chose to work on advocating for my patient. I feel this is very difficult for new nurses, and as time goes by and I gain experience and confidence, it is becoming easier for me. However, I will have to work hard to maintain this confidence as a new ICU nurse.

I often find myself worrying too much about other’s image of me. I find that I can get a little too anxious and stressed out, often going home and worrying about what I missed, and if I did anything to make the next shift mad. While I think it’s great to reflect on your own practice and look for weaknesses, I feel that there is a balance and you need to find the positive. For example, try brain storming the things that you didn’t miss that others may have, or what did you do that may make the next nurse happy with you.

8. Tell me about a time in which you had to handle an irate physician, co-worker, or patient. How did you handle it and what were the results?

I will always remember one incident. I had a patient that was doing very well. As a result, the physician discharged her. Everything went fine, the patient was more than happy to go home, and her daughter came to pick her up and take her home.

About two hours later I received a phone call from the patient’s son. He was livid that we had discharge his mother, in his words, “way too early.” She wasn’t eating as much as she usually does, she was still having to take pain meds, and she sometimes needed a bit of help to get to the bathroom.

In my life, I have learned that there are two things that can help diffuse a situation with someone. The first is that you actually have to listen to a person’s concerns, and the second is that you have to struggle to make a connection with the person.

I was more than tempted to simply tell this gentleman that what his mother was experiencing is perfectly normal for someone that has just been discharged, but instead I listened. Instead of cutting him off and interjecting, I asked him to describe more. I knew his mother was more than likely fine, but I asked him (telephone triage style) to describe is mother’s condition. I assured him that if he was worried about his mother, I was worried. I had him describe her colour, had him do a full pain assesment, and check her incision. I stated that what he was describing didn’t give me cause for concern. But I made him get a pen and paper so I could give him a list of every possible symptom that would give us concern.

Then the unit clerk accidentally hung up on him…

When I called him back, I was worried about how mad he would be about being hung up on. Instead, I managed to get him laughing about it. There was our connection.

We continued talking and I found out that his father had had a simple surgery two years earlier. The day he got home, he dropped dead from a pulmonary embolism–and he was always mad because he thought the hospital had discharged him to early and that it had caused his Father’s death.

The real reason for his anxiety was discovered simply by taking the time to talk to him.

We ended the conversation smiling.

9. Describe a difficult decision you’ve made and the process you went through to reach that decision.

The most difficult decision I made was whether or not I would apply to work in the ICU. I had struggled between the opportunities offered by my current unit versus my goal of working in the ICU.

I made the decision by weighing the pros and cons of each opportunity. For example, my current unit offers the opportunity to precept students and orientate new nurses–I love teaching! I would also miss out on the chance to learn the charge nurse role.

However, I knew that regardless of what I chose, I would be applying to the ICU eventually. And while it wouldn’t occur immediately, I would eventually have the chance to teach new nurses, and I would potentially be able to learn the charge nurse role in the future. But, in the meantime, I would be working toward my ultimate goal.

Due to these thoughts, and similar input from friends and coworkers, I made the decision that I would start applying to the ICU.

10. What is most important to you in a job?

Working as part of a team, having the chance for human contact, being able to teach patients/families/nurses, the opportunity to learn new technologies, complex patients that really make me critically think, good stress through being challenged, and good relationships between all disciplines.

Sean Musings