A self-proclaimed millennial, Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P, is serving a one-year term as president of the world's largest specialty nursing organization, the American Association of Critical-Care Nurses (AACN). [caption id="attachment_106008" align="alignright" width="250"]
Amanda Bettencourt, APRN[/caption] We spoke with Bettencourt about her concerns for critical care nursing, what she loves about being a critical care nurse, how the pandemic changed the nursing specialty, and more.
Q: What are the most pressing issues for critical care nurses?
A: The first would be the staffing crisis. A 2021 work environments survey done by AACN found that only 24% of the responding nurses said they have appropriate staffing levels more than 75% of the time.
There is a floor below which safe nursing care can't be delivered, and that's true in the ICU just like it's true everywhere else.
Another concern, which is not limited to critical care nursing, is a lack of nurses' voices in crucial decision making. We need to make sure that nurses are at the table and their input is valued when important decisions are made in hospital settings, whether it's about patient care or policies and procedures that affect the way that we work. Broadly speaking, both issues can be addressed by implementing the AACN Healthy Work Environment Standards. There is so much evidence that when work environments are healthy, nurses are more satisfied, they provide better care, and patient outcomes are better. Another big issue that we're dealing with, especially in critical care, is how we support new graduate nurses who are entering such a volatile healthcare environment. They're facing shorter orientations with fewer educators and clinical nurse specialists. There are fewer layers of the support that used to be present in the hospitals to help their transition to practice.
Q: How do experienced and new nurses become ICU nurses?
A: I was fortunate as a new grad to go directly into the pediatric ICU. When I graduated from nursing school about 15 years ago, it was more common to work on the medical-surgical unit first to get a few years of experience before moving into critical care. What the pandemic has shown us is that there are many paths to becoming a critical care nurse. Today, there are lots of opportunities, such as in a residency program -- which a lot of hospitals have -- or finding a supportive environment where you like the nurse manager and feel your growth is going to be supported to "try out" the ICU and see if you like it. In critical care, there are so many critical care specialties -- neuro ICU, trauma ICU, cardiac ICU, pediatrics, neonatal, and medical ICUs. In a residency program, you can usually experience all the different types of critical care and choose the one that fits best. Finding that place where you feel like you fit is so important. You want to enjoy the patient population and know that you're making a good contribution, but you also want to feel like you have a good team supporting you.
Q: Did the pandemic change critical care nursing?
A: There were changes -- most out of necessity. Just having to put on all of the personal protective equipment before entering patients' rooms made care different. We weren't able to rush into rooms. Some of our colleagues are no longer entering COVID-19 patients' rooms with us, so our team-based care approach in critical care changed a little. COVID-19 drove change in where we kept IV pumps. Those were traditionally in the room with the patient, but because we couldn't put on the PPE all the time if the pump was beeping, we innovated, keeping the pumps outside patients' rooms. Fundamentally, though, what nursing looked like before the pandemic and what nursing care looks like now inside the ICU are basically the same.
Q: Would you say nurse burnout is different for critical care nurses than other specialties?
A: Nurse burnout is driven by different things in critical care nursing. What causes burnout in a high-stress, critical care nursing specialty is different than what causes burnout in a more planned surgical area of the hospital. But I think the factors that drive all nurses to burnout are basically the same. We work in stressful environments that are constantly changing. It's emotional and physical work. A lot of times we have to witness or participate in things that are stressful and are distressing to us. For me, running, biking, and music help me process the things that I have to witness in my daily work. These things help me buffer against the effects of burnout. Nursing is stressful, but it's also rewarding and one of the best jobs ever. I think finding that outlet for processing emotions in a healthy way is really important.
Q: What would you say to nurses who are thinking of leaving the specialty because of the challenges of the past two years?
A: Studies in our specialty and others are showing that more nurses are thinking about leaving their jobs and the profession. That's likely because the systemic problems that have long existed in our healthcare system surfaced during the pandemic.
Nurses are processing the grief and suffering that they had to witness at that time with such sick patients. Nurses who were on COVID-19 units really need additional time and support to process that grief, put closure on the pandemic, and make sure their mental health is okay. That may make this group of nurses especially vulnerable to leaving their jobs or the profession.
Q: What would you say to nurses who are just joining the specialty?
A: First, I would say, welcome! You are joining an amazingly important specialty, and we need you. Critical care nursing is hard, but it's also so rewarding. Nurses who are joining the critical care specialty should be prepared for the fact that there are a lot of highs and lows. Almost always, the highs outweigh the lows. The ability to be with a patient and family through the most stressful, traumatic experiences of their lives in the intensive care unit is the most rewarding nursing work that I can imagine. I would say, of course, it's going to be a challenge. There is a lot to learn. But it is one of the most supportive work teams in the hospital. It is one of the places where, as a nurse, you can have the biggest impact on the patient and family.
Q: Tell me about the AACN's theme, "Starting Now."
A: When I was thinking about what I wanted our theme to be this year and how our nursing community was feeling after the years of the pandemic, I thought about the times in my career where I felt demoralized, tired, burned out. I thought about my own nurse journey and how I coped with those things in the past. Even though some things that I've witnessed in my practice gave me moral distress, the way I grew and learned from it was to take action and create change. We all want a better future for nursing and for our patients. Starting Now is as simple as taking what has transpired over the past few years and each of us taking a step toward doing something that creates a better future for ourselves and our patients. Starting Now means wherever you are in your career, no matter what that step is, take it now.
Q: What are your personal goals for your tenure as president through June 2023?
A: I have three goals. The first is to inspire our nursing community. Like with Starting Now, it's time to turn the page on what we've experienced and take action to create a brighter future. The second is to help us all connect and find community for healing and hope. It has been such a strange thing during the pandemic because those core teams of support that we've worked with in the ICU are no longer there. People have left to travel or stopped working or are no longer with us because of COVID-19.
What I'm hoping, as president of the AACN, is that we can help create a place where nurses can find community, find support, nurturing, education, and hope for a better future together.
My third goal is to make sure that people who are thinking about joining an organization like the AACN can see themselves fitting into the organization. I'm a millennial and am in the middle of my nursing career. By virtue of me being a millennial and in this role, I hope that nurses who are in the early stages of their careers, but are driven to change things in health care, will see me and know it's possible to be the leader of a big nursing organization no matter what stage of your career you are in. Ready to join a nurse community? Try our social networking app. Exclusively for nurses, the app gives you access to an online community dedicated to empowering and connecting nurses. 
