Personal reflections working on our critical care unit
I joined the ICU of the Royal London Hospital in February 2007 as an ‘E’ Grade Staff Nurse and my memories of the first few months are of shock at the size of the new unit I had joined, the diverse range of patients admitted, the fast pace of patient turnover, and the sheer number of other staff I had to get to know! I won’t pretend it wasn’t bumpy at first, but what quickly got under my skin was the acuity of the patients and the exposure to neuroscience and trauma critical-care. These were the days before trauma provision in London had been formally organised into networks, but I already knew that the Royal London had become London’s first Major Trauma Centre (MTC) by default, and that it was pioneering the way in trauma care and enhanced outcomes in severely injured patients. Fast-forward almost 12-years, and the 18-bed ICU I joined in an ancient, crowded and crumbling (but much loved) Georgian building is now a 44-bed generic ‘Adult Critical-Care Unit’ in an immense 17-storey modern hospital which towers above Whitechapel High Street and dominates the East London skyline, even before you see London’s Air Ambulance circling the Helipad!
In my own way, I have changed equally. This is, by and large, due to the vast array of different opportunities I’ve been able to take advantage of. The first of these was being able to access specialist courses in trauma and neuroscience nursing during my early years at the Trust. After six-months I gained a place on an in-house pilot course in trauma nursing run by a very experienced lecturer-practitioner who had managed to persuade each of the hospital’s trauma surgeons to give up their time to come and teach a small group of ICU and ward nurses about the vast array of traumatic injuries commonly seen in the hospital. It was a very clinically-focused and clinician-led course and it was the perfect introduction to the principles of trauma nursing.
Two years later (and with a lot more experience under my belt) I was able to undertake a neuroscience critical-care course, which then led to a 6-month stint working as a Practice Development Nurse on the ICU with particular responsibility for neuroscience practice development. I then became a Band-6 Charge Nurse and, alongside direct patient care, I spent 4-years helping my Band-7 team leader to support, mentor and manage junior members of the nursing team. I also got experience of regularly managing a team of 14-nurses on a shift-by-shift basis and, eventually, managing the unit overall as a deputy for the Band-7 team leader when required.
It was during this time that I became interested in finding out more about longer-term outcomes and what happened to our patients after they left the critical-care department. The ACCU runs a Critical-Care Follow-Up Service, which reviews former critically-ill patients as outpatients after their discharge from hospital. I got the chance to become involved with this and spent four very happy years helping to run the monthly clinics and contributing to changes to make the service more responsive to patient need. One of the biggest enhancements to the service at this time was the appointment of a much-needed Clinical Psychologist – one of only a handful of dedicated ICU appointments in the whole of the UK – to provide psychological and emotional support to patients and their relatives, and help signpost to other support services beyond the hospital. This role has gone from strength-to-strength and demonstrates the commitment of the ACCU not just to the physical care of our patients during critical illness, but their psychological wellbeing too – and that of their families and loved ones.
In 2015 I spent 6-months working as a Trauma Nurse Co-ordinator at another London MTC. This gave me a powerful and valuable insight into trauma care within the wider hospital, rather than just the confines of ICU. It was also good to gain experience of how a different MTC works. It really made me appreciate that there is far more which unites than divides us as organisations across the NHS working towards the same goals - with the same constraints, challenges and frustrations. I also realised two other things: firstly, that I am an ICU nurse at-heart, and secondly, that my heart really belonged to the Royal London Hospital. So I returned to critical-care nursing at RLH and, shortly thereafter, got the opportunity to apply for my current fixed-term role as a Critical-Care Research Nurse with the Centre for Trauma Sciences (C4TS) based at Queen Mary University of London, which works in affiliation with Barts Health NHS Trust and the Royal London Hospital.
Led by Professor Brohi, the C4TS Team initiate and work on a range of non-commercial trauma research projects. These are aimed at enhancing our understanding of the way in which trauma affects the body to increase our ability to provide targeted therapy from the point of injury, through critical-care, the acute phase of recovery, and beyond. The ultimate aim is to improve outcomes, refine pathways of care and add quality-of-life to survival after major trauma. As part of this I am working on a 2-year observational study which compares organ dysfunction and longer-term outcomes in elderly trauma patients with those of younger trauma patients, to identify if differences exist and how these might best be addressed to improve the care of elderly trauma patients, who are a growing population across the London Major Trauma System.
The study is running at each of London’s four MTCs, which means that I get to work across traditional organisational divides. This is a unique opportunity and really helps you to see and appreciate ‘the bigger picture’ in terms of the strengths and challenges of providing major trauma care in a city as large and diverse as London. I also have an honorary contract with Bart’s Health, which means I can continue to undertake clinical shifts on the ACCU at the Royal London as my research workload allows. This is important as it enables me to remain connected to hands-on patient care and allows me to maintain my critical-care skills. It also means I can keep my career options open for whatever opportunities lie ahead.
My colleague and I are the first two research nurses to be appointed to the C4TS team, and the Chief Investigator of the study (and my boss!) is also a nurse and none other than the inspiring lecturer-practitioner who ran the trauma course I undertook as a new staff member way back in 2007 when I first joined the Trust. All of these things make me feel very proud of the way in which nurses are pushing the boundaries of traditional practice and contributing to the research agenda in trauma care. Another recent personal highlight was teaching on the contemporary Critical-Care Trauma Course, run in-house by the ACCU Practice Development Team, and accredited by City University. Being able to get involved with innovative research and teaching projects like this makes me feel that my career at the Royal London Hospital really has come full circle. Looking back, I feel very happy about, and grateful for, the many different opportunities I’ve been given over the years through coming to work here – not to mention the outstanding nurses and countless other professionals I have had the privilege to work alongside, many of whom I am lucky enough to now count as firm friends. The Royal London Hospital and ACCU has been a huge part of my life and I hope that it will remain so for many years to come.
Robert Christie
Critical-Care Research Nurse, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London
Honorary Charge-Nurse, Adult Critical-Care Unit, (Wards 4E & 4F), Royal London Hospital