June 14th, 2012
By Jennifer Olin, BSN, RN
Earlier this week I wrote about the rise of the tele-ICU. Once again, it is an e-life we are living and e-careers we are pursuing. I recently had the pleasure of speaking with a veteran nurse who has left the actual hospital for a warehouse full of computer equipment and monitors yet still works in the ICU.
Connie Barden, RN, MSN, CCRN-E, CCNS is a great conversationalist. She’s interesting, engaging, knowledgeable, and oh so positive of attitude. She is also working in southern Florida in one of the first tele-ICUs in the country.
Tele-ICUs have only been around for a while, what were you doing before you landed here?
“I’ve been a nurse for 37 years, in critical care the whole time. Believe it or not, when I got out of nursing school in the 70s there was a nursing shortage. My first choices were SICU or L&D and I got lucky, there was an opening in the SICU so I took it, cardiac care actually.
”It was great; I was absolutely a fit. I had amazing development and nurturing from the nurses who trained me. We had weeks and weeks of nursing training and time to grow up as a CCU nurse. “
Barden came to Florida in the 1970s then, “In the first part of the 80s I went to get my Master’s, my MSN, with a focus on cardiovascular nursing at the University of Alabama. They also had a curriculum to become a Clinical Nurse Specialist (CNS). “ So she added that to her education as well.
What drew you to the CNS role?
”A CNS is an advanced practice nursing role that is traditionally seen as having multiple responsibilities: the care of more complex patients; consulting with nurses in other units; research, and education to name a few. I love it. You really get to be involved in the most complex cases and you get to teach. There is so much to developing and growing and nurturing the nurses’ role. It is the role of the CNS that I really love.”
So how did you end up in the electronic world of critical care nursing?
“I had morphed from a CNS to the Director of Clinical Safety and Innovation at my last job. This hospital had already opened their tele-ICU in 2005-2006.”
In 2008 or 2009 Barden was speaking with a friend, another critical care nurse she had known for years. She was the head of the tele-icu and was getting ready to expand and she needed an educator. Barden took the job.
This doesn’t sound like your run of the mill nursing education job. How do you see it?
“We are really different in the eICU. We are remote from every hospital in our system. We are actually housed in a warehouse. Our regular staff of nurses and physicians are here 24/7 monitoring 125 patients if all the ICU beds in our six hospitals are full.
”My job is to make sure the nurses are on the top of their game. I electronically make rounds on the patients; what are their needs, what can we learn from them?
”The key to the system is the unique relationships between the tele-ICU and the bedside nurses—that’s critical. I also go to the various hospitals, go in scrubs and work on our relationship building. It’s great being present at the bedside and being there remotely.”
What is the communication like between the tele-ICU and the actual ICU?
”There are audio and visual links in almost every patient room. The nearest hospital is eight-10 miles away. Each room has a video camera facing the bed but 90 percent of the time it is turned off and facing the wall. We monitor the electronic info from the monitors on the patients. The doctors and nurses are on headsets and they ring a doorbell when they want to interact with the bedside nurse, the patient, or the family.
”If there are med orders that are needed we can get them. If a nurse is in the process of hanging 4-5 drips and they don’t know what can go with what, we say ‘hang on, and we’ll get back to you in five minutes with that.’ We are really there to support the nurses.”
Seems like a pretty big change from 1-2 patients and working at the bedside.
”This is the first time I have ever worked outside the walls of an actual hospital. I was drawn to this because it is one of the new models that can really help us deliver patient safety and nursing backup. We keep patients safer and things move more smoothly.
”We’ve prevented over 60 falls using this system. Our nurses average 15 years of experience working in critical care. When they see a lot of artifact or tracings we can turn on the camera and take a look. We see a leg out one way and an arm out another—it’s quick phone call, ‘you’ve got a patient trying get out of bed.’
”It’s so high tech, nurses doing regular rounds, going room-to-room by camera. “
But there is still a personal side to all this high tech, right?
“The patients get used to our voices. One night the nurse was rounding and she chatted with the patient for a few minutes. This was before the rooms had video monitors so it was voice only. The nurse said the patient was sounding teary, she said she was getting scared. She asked the nurse, “will you pray with me?” Over the speaker the nurse prayed with her for several minutes. The patient was so appreciative. Our nurse was very intuitive, tuned into the patient.
”You just push this stuff to the limit. We can help shift how healthcare is practiced in the future.”
The possibilities seem wide open, particularly for patients in rural hospitals.
”In the eICU system out in South Dakota, they care for patients in five states. Instead of patients having to be transported to a far away big medical center, with this we can keep people in their own locale a lot more often.”
What do you see for the future here?
”One major goal is optimizing and maintaining relationships with the bedside. I would also love to see us begin to reach out to the smaller, rural hospitals with this type of care. It’s like a hub and spoke system. We’re here in Miami as the hub and the rural hospitals are the spokes, just like our system’s hospitals are now.“
What advice do you have for nurses who think this is the arena where they belong?
”It takes an experienced critical care nurse, at least five years experience. The nurse must really know what they are doing. They should get certified; CCRN certification is the most common. And most important of all, you must have excellent communication skills, collaborative skills. You must be excellent at customer service. “