Fiona, Clinical Nurse Specialist, Intensive Care Unit | Staff Feature

Fiona

Registered Nurse and Clinical Nurse Specialist

Abbotsford
Abbotsford Regional Hospital Cancer Centre
Nurses> Clinical Nurse Specialist> Intensive Care Unit
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I love the diversity of work that nursing offers, particularly the learning and growth [opportunities] in the intensive care unit (ICU). Over the 10 years of working in the ICU at Fraser Health, I have had the opportunity to pursue specialty nursing education (SNE), participate in many leadership and mentorship courses and grow in my leadership roles with the support of my team. I started as a bedside registered nurse (RN), and grew into a patient care coordinator role, then a clinical nurse educator role, and now I am a clinical nurse specialist. I continue to learn something new, interesting and challenging each day.

The ICU team at Abbotsford Regional Hospital and Cancer Centre (ARHCC) is the hardest working and most engaged team I have worked with in my career. We have a phenomenal nursing team that works together collaboratively and are always keen for change, new technology and innovative ideas to improve patient care. We also have team building education days and competitions between staff on the unit. My leadership checks in with me regularly, supports my ideas and suggestions. They also support my professional development by giving me time off to attend education and conferences.

Recently, our team initiated a registered nurse (RN) led Quality Improvement (QI) project which looked at decreasing delirium in ventilated ICU patients. Up to 80 per cent of patients on a ventilator will experience delirium that can lead to Post-Traumatic Stress Disorder (PTSD). One-quarter of all ICU patients suffer from PTSD once they leave, a rate that is comparable to PTSD diagnoses among combat veterans and rape victims. Patients with ICU delirium are less likely to survive and more likely to suffer long-term cognitive challenges if they do.

ICU has traditionally used observational scales (RASS) as the gold standard for ICU care for nurses to follow to sedate ventilated patients. These scales, give nurses leeway to make subjective decisions about how much sedation to administer to patients to meet their defined clinical goals. Historically, patients are frequently over-sedated which has downstream consequences of increased rates of delirium, days on a ventilator, and days in the ICU. This project used the technology of processed electroencephalogram (pEEG) monitors, continuous neurological monitors to titrate sedation. The pEEG monitor gives RNs a quantifiable measurement to target a patient’s level of sedation. By using these monitors to guide sedation, in one year we have reduced delirium by 64 per cent and ventilator days by 36 per cent. Importantly there were no adverse outcomes related to decreasing sedation in the pEEG monitored patients.

Outside of work, I love hiking all around the Fraser Valley, spending time with my dog in our beautiful scenery, swimming in our lakes, and taking photographs everywhere I go. I love that Abbotsford is small enough to know people but large enough to have lots of different restaurants and activities.

Fiona recommends anyone considering a career as a specialized nurse in the ICU to, “be courageous to try new jobs and see if it is a good fit. I would also recommend considering leadership positions – it is always worth trying.”

 

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