Specialty Spotlight: Caring for Patients in a Neurological ICU (Podcast)

After working as a clinical nurse in the bone marrow transplant program at Cleveland Clinic Main Campus, David Lucas, MSN, RN, AGACNP, decided to shift to critical care. There were job postings in several areas, including surgical, neonatal, cardiovascular and neurological ICUs.

At first, Lucas was unsure about neurology – it was one of his least favorite topics during nursing school. But he landed a job on the neurological unit and hasn’t looked back.

“I instantly fell in love with the culture on the unit, and a little later on I fell in love with the patient population,” says Lucas. “I feel like I’ve found my niche there.”

Lucas, who recently became an acute care nurse practitioner in the neurological ICU, discusses the nursing specialty in the latest episode of Cleveland Clinic’s Nurse Essentials podcast. He covers:

• The diagnoses and diseases treated in the neurological ICU
• Technologies and tools used by providers and nurses to care for patients
• Onboarding and education required in the specialty
• How to support patients who face a long journey back to health
• Advice for assessing the neurological status of patients on any unit

Click the podcast player above to listen to the episode now, or read on for a short, edited excerpt. Check out more Nurse Essentials episodes at my.clevelandclinic.org/podcasts/nurse-essentials or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: What are some things that you and your colleagues can do to really help support the patient knowing that that journey is long?

Lucas: Great question. Like you said, we see them at their sickest. So, we treat them, we get them stabilized and then we send them off to the step-down unit or an LTAC [long-term acute care hospital] to help wean off the vent or a rehab facility to start trying to work on the deficits that have occurred.

Physical therapy and occupational therapy work from the rip. So, a patient comes in. As long as they're stable enough to work with, we try to work with them because typically, the sooner we start to get patients up and trying to use the arm that doesn't work anymore or work on the language skills that were here yesterday and they're gone today or whatever the case is, we found the better it becomes.

I feel like we've seen two different types of patients. First, the stubborn person who's done everything for themselves all throughout their life and now they can’t and it's really frustrating. And they're trying to get up out of bed, and those moments, nurses need [to say], "Hey, listen, I love the enthusiasm, love that you want to get up and work, but we need to make sure that you're safe first." So, setting those boundaries: "We're going to work with physical therapy now and then after that we're going to rest."

And then on the flip side, you get the patients who are just really bummed. They're just like, "I can't move. I can't do anything anymore. What's the point?" And so that's when we kind of turn into cheerleaders, so to speak, and really try to encourage as much as we can. "Hey, listen, physical therapy might be hard. Occupational therapy might be frustrating. But you know, when we work at these things, when we do these things, that's how you get better. That's how you hopefully are able to get back to close to your baseline.”