Carol Ball, RN, MAS, remembers the good, old days of critical care nursing in the late 1950s and early 1960s when she could work as an intensive care nurse while she was still a nursing student.
At that time, even the sickest patients were housed in large, general wards, and “intensive care” meant personally hiring a private duty nurse or nursing student to devote all of his or her attention to a single patient.Photo by Keith Weller
Carol Miller, RN, BSN, CCRN
“In the early days, that did work toward improving the survival of critical patients, but their chances of survival have drastically improved since then,” says Ball, who now is the senior director of nursing and administration at Johns Hopkins Bayview Medical Center in Baltimore.
The CPR Revolution
The revolution in the development of modern critical care began in 1956 when Peter Safar, MD, conducted the first CPR experiment in an operating room at Baltimore City Hospital (now Johns Hopkins Bayview).
“He also understood that CPR is not enough and that you need a group of people and a system to stabilize and take care of resuscitated and critically sick patients,” says Romergryko Geocadin, MD, an intensivist who worked with Safar as director of the neuroscience critical care unit. “He realized that you do not need only smart physicians and smart nurses, but you need a comprehensive team.”Jonathan Sezransky, MD, and Zeina Khouri-Stevens, RN, PhD, director of nursing, department of inpatient surgery, helped organize the Bayview celebration.
Two years later, Safar went on to develop the first multidisciplinary ICU in the country at Baltimore City Hospital. It was a mixed unit that cared for patients with any critical condition.
On Sept. 26, nurses and healthcare professionals from Bayview celebrated the ICU’s 50th anniversary with a day-long event.
In the late 1950s, use of the iron lung was being phased out and the positive airway pressure respirators were a hot new technology. Respiratory therapists had not yet appeared and all pulmonary care was done by nurses. Sophisticated cardiac monitoring systems, pulse oxcimetry, and IV pumps did not exist. ICU nurses mixed all their own medications and needed to develop sharp assessment skills and a keen sense of gut instinct to maximize patient safety.
“In the beginning, it was low-tech, and nurses used more of the art of nursing,” says Ball.
Today, there is a great demand on nurses to keep up with a constantly evolving plethora of new medications, treatments, technologies, and best practices. All this adds up to a broader scope of practice for nursing, including performing more sophisticated physical assessments and interventions, according to Ball.Maria Koszalka, RN, EdD, vice president of patient care, was part of the day-long celebration at Johns Hopkins Bayview Medical Center.
“Nurses now must know the science of nursing as well as the art of nursing,” she says.
The 1970s and Beyond
By the end of the 1970s, Johns Hopkins Bayview critical care RNs were practicing in specialty areas including the burn unit, which opened in the 1960s and the CCU, which opened in 1971. Critical care continued to expand when a NICU was added and the combined med/surg/neuroscience ICU was separated into separate specialized units.
Carol Miller, RN, BSN, CCRN, started at Bayview as a graduate staff RN in 1992 in the combined med/surg/neuro ICU unit.
“From a nursing standpoint, I really got a well-rounded clinical experience,” says Miller, who now is the SICU patient care manager. “There are major differences in the care and treatment of medical, surgical, and neurological patients, and it was very challenging to work like that. ICUs are more specialized now, and I’m now really able to concentrate on surgical patients and how to manage them.”
The multidisciplinary team has grown since the 1990s with the addition of intensivists, nurse practitioners, clinical nurse specialists, and physician assistants who specialize in critical care. There is also more rigorous collaboration with professionals such as physical therapists, social workers, and dieticians.
“The addition of advanced practice critical care nurses really helped to bridge the gap between the nurse and the physician,” says Miller.
The advent of nursing’s involvement in daily rounds and goal sheets and other safety-driven initiatives also have improved patient care and outcomes.
“Back in the ’90s, I remember not having much autonomy or say in patient care,” says Miller. “Wow, what an improvement over the years! Today, I am basically the team leader in that conversation. It’s what nursing’s always fought for.”
Catherine Spader, RN, is a contributing writer for Nursing Spectrum.
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