A Day in the Life of a Trauma ICU Nurse

BY JIAO JIAO (MELISSA) ZHANG, RN, BSN AND CURRENT DNP STUDENT | NOVEMBER 6, 2018

When people find out that I am a trauma ICU nurse, the common reactions are “That sounds tough” or “You must see a lot of awful stuff.” Yes, I do. But I also see a lot of miracles and healing. We get many gunshot, stabbing and motor vehicle accident patients, but surprisingly, the most common admission that we have are falls.

As a trauma ICU nurse, I work alongside an interdisciplinary team consisting of surgeons, anesthesiologists and nurse anesthetists, emergency residents, attendings, physical and occupational therapists, respiratory therapists, nutritionists and social workers. On average, each nurse has up to two patients per shift. That might sound like a dream nurse-to-patient ratio but on some days, depending on how critical they are, it can be two too many.

The trauma unit also acts as a post-surgical ICU where we care for post op patients from neurosurgery, head and neck surgery, back surgery, post kidney transplants and organ donation.  The levels of critical care fluctuate throughout each shift.  It is a fast paced, on your feet and physically demanding job.

A typical day for me starts at 7:00 a.m. I receive report from the night shift nurse regarding the past medical history and conditions of the patients throughout night. My first patient had just arrived to the unit due to a motorcycle accident. The patient sustained bilateral rib fractures, a hemothorax where a chest tube was placed in the emergency department, spleen laceration, open pelvic fracture, and a femur fracture. Because the patient’s vital signs are unstable, the patient cannot safely be transported to the OR for any surgery. He needs to be stabilized before the patient can even be considered a surgical candidate.  That’s where the trauma ICU nurses come in.

Throughout that day, I work to maintain intravenous sedation medications to keep the motorcycle accident patient comfortable. I perform mass transfusion of blood products at an accelerated rate to stabilize the bleeding while working with the surgery residents to place central venous and arterial lines for access. We also stabilize the multiple fractures with orthopedic residents at bedside to prevent further bleeding.

The second patient is an organ donation patient. The patient has a history of severe depression who had a self-inflicted single gunshot wound. Neurosurgery had already confirmed brain death testing and the family has agreed to donate all of the patient’s organs. My job is to work alongside the residents to maintain the patient’s physiological stability as Upstate New York Transplant Services (UNTYS) places the viable organs for donation.

Not every day is as hectic as the example I gave, but they are all very gratifying. While it is extremely sad to have a self-inflicted gunshot patient, it is reassuring know that the organs will be donated to save many lives. It is even more rewarding when I saw the motorcycle accident patient walking back into the trauma ICU six months later for a visit and to thank us for saving his life.

*Patients' details have been changed to protect their identities.

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