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Daniel—Registered Nurse
Palliative care
Metropolitan Melbourne

On Friday 8 October 2021, I was just about to leave home for a night shift on the palliative care unit—PCU—when my manager rang me. Given they normally worked until 5pm and it was now 7pm, my first thought was that there must have been an incident at work that involved me. I was wrong; they asked me if I wanted to be redeployed to the ICU—the intensive care unit.

My manager had attended an emergency meeting and had been asked to redeploy at least one staff member to ICU to help address the staffing shortfall. There was little more information than that; training had not been decided; the model of nursing had not been decided; only the need was clear. They needed my response by Monday.

I hurried off to night shift and endeavoured to explain the situation to my wife over the phone on the way, despite barely understanding what was on offer myself. After talking it over with my family during the weekend, I agreed.

The redeployment was to finish around January 2022—three months later. I was to have my last palliative care shift that Friday and start the following week in intensive care. My roster was now redundant, and I hadn’t the faintest idea what was happening for the rest of the year. This wasn’t to improve as, by my second month in ICU, Omicron had hit and my reallocation was extended to April 2022, a total of seven months.

ICU pulled some strings and organised a day of in-person training followed by three supernumerary shifts where I would be working on the ward in addition to the existing staff. The training felt rushed, skimming over topics like ventilators, lines running into arteries rather than veins (arterial lines) and drugs to decrease blood pressure (vasodilators). I had little knowledge or experience of any of these.

The following day, my first supernumerary shift, I was confronted by a patient connected to a ventilator via a tube through the mouth into the throat (endotracheal tube), something of which I had no experience, and a machine replacing a patient’s kidneys twenty-four hours a day (CRRT), something I never knew existed.

The second day, I encountered a patient in their fifties with no comorbidities. They had been in ICU for a month recovering from COVID and remained on a ventilator via a tube through their neck (tracheostomy). This was my first experience of the effects of COVID. It introduced me to the fact that some of the ICU COVID patients were no longer active COVID patients—they were laboriously trying to heal post-COVID.

I had already used PPE many times before in my nursing, but only for minutes at a time. Entering the COVID pod meant remaining in PPE for hours at a time, and it was an ordeal. The first day in the COVID pod, I took off my PPE to find my entire scrub top drenched with sweat.

Every day started with a self-administered PCR test. It was dutifully sent off and, thankfully, every day I got back a negative result. Despite my exposure to COVID-positive patients, I didn’t catch COVID until long after my stint in ICU.

My patients were varied but often stable. Yet even with the lowest level of care, there were significant differences to what I was used to. I was used to palliative patients where daily vital signs were the norm, three times a day if they were particularly healthy. Low blood pressure or a high rate of breathing often meant that a patient was dying, so we frequently ceased checking vital signs at that point. After all, why collect numbers when you aren’t going to try and change them? Medications administered intravenously into the veins or via lines directly to the heart (CVADs) and taking blood samples were a once-in-a-month occurrence.

ICU was the opposite. We checked patients’ vital signs, fluid intake and output every hour. Every day, often more frequently, we would check our patients’ blood and their heart rhythms (ECG). Everything was maintained within precise parameters with all the tools at our disposal. Every patient had numerous intravenous medications, most running into CVADs. A patient in my first week by myself had a vasodilator, a sedative and pain-relief medication running into them, which I had to increase and decrease to maintain a careful balance of blood pressure, sedation and relief. I had only once before seen an arterial line, but now many of my patients had one and I learned the infuriating fiddling that was sometimes required to measure blood pressure with them.

I went through my old uni notes. I signed up for online courses. I asked more experienced nurses. I did what I could to stay on top of everything. The ICU team was great: I felt supported and I felt needed. Yet my mind repeated the same phrase, ‘What the hell am I doing here?’ It was imposter syndrome at its finest, exacerbated every time a major medical emergency occurred. In PCU, I knew what needed to be done; in ICU I felt like I hadn’t the foggiest idea…and it hurt to admit it.

Every day since March 2020, we had been receiving daily updates of numbers. When I first got to ICU in October 2021 we were at peak Delta and two areas were filled with COVID patients. The patients were very sick, the majority on ventilators and staying for weeks. By April 2022, there was no dedicated COVID area. Those who came in with COVID were frequently incidental discoveries; they came to ICU with some other diagnosis and were discovered to be COVID-positive through a routine PCR.

By the end of my redeployment, I found myself managing ventilators with more understanding, effectively determining the right dose of medication for each patient, troubleshooting arterial lines and handling the demands of my ICU patients. My new ICU colleagues asked if I would consider staying longer and I genuinely considered the possibility. But I chose to return to PCU because that was where my passion was. ICU gave me confidence, countless clinical skills, friendly colleagues and more, but at heart, I was still a palliative care nurse.