In Conversation With: Two AHPs on finding their place in intensive care
In the first of our In Conversation With series, we meet Jemma Smith, a Band 6 Occupational Therapist at Bristol Royal Infirmary, and Bethany Wrenn, a Band 5 Rotational Physiotherapist at Royal Papworth Hospital.
Two professions, two different journeys into intensive care, and the experiences that make it all worthwhile.
From ballerina dreams to intensive care
For Jemma, Occupational Therapy runs in the family.
Jemma: “I am fortunate to have come from a family of Occupational Therapists! My mum is an OT from South Africa who has spent most of her career working in mental health and neurodevelopmental services and my paternal grandfather was an OT Technician in a small, Cornish community hospital back in the 80s/90s. So, naturally, when my dreams of becoming a fairy princess ballerina fell through, I chose to apply for my undergraduate OT training - mum was thrilled (yes, there were tears).”
For Bethany, it was the practical nature of physiotherapy that first appealed.
Bethany: “I wanted to become a physio because I enjoy the practical side of helping people, the problem solving involved and seeing patients progress first-hand.”
Their paths into intensive care were different, but both found themselves drawn to the opportunities and challenges of working in such a complex environment.
Jemma: “As a Band 5 at the Bristol Royal Infirmary, I joined the cardiac team and got the opportunity to in-reach to our general and cardiac intensive care units to meet patients due to be discharged onto my ward. Here, I met James, a clinical specialist OT in critical care, who introduced me to ICU, where my passion for this burgeoning, innovative area was born.”
Bethany: “I qualified in July 2025 and started band 5 life at Royal Papworth Hospital in October 2025. I enjoy the complexity of the work involved in ICU, as well as the multidisciplinary aspect and the pace.”
Jemma: “Not long after this, I successfully interviewed for a static band 6 position in the critical care team and I have been immersed in all things ICU ever since.”
Not quite what you’d expect
Bethany: “Being on ICU is different to being on the ward because the patients are much more medically unstable with many more attachments to contend with.
I enjoy the variety of patients I see, and as every patient is so different it helps to build on and test my clinical reasoning daily.”
Jemma: “Occupational Therapy in ICU is relatively new, compared to our other AHP colleagues, and we are still very much carving out our niche. We are fortunate here at the BRI to be guided by James’ years of clinical experience. My day can range from splinting the hands and arms of sedated patients for joint range and protection, to early mobilisation, to supporting people through our follow-up clinics to adjust to life after an ICU admission.”
Jemma: “What generally surprises people about my role is how early rehabilitation is enacted on ICU. Positive risk-taking to enable participation is fundamental to OT practice generally, but this is magnified in critical illness recovery. Immobility drives delirium, can contribute to respiratory distress, and negatively impacts long-term functional outcomes and quality of life.
The sooner we begin rehabilitation, the better our patients recover!
Bethany: “It often surprises people that intensive care physiotherapists mobilise patients on advanced mechanical circulatory support devices such as Extracorporeal Membrane Oxygenation (ECMO) and biventricular assist device support (BiVAD).”
Working with patients who have such complex needs brings its own challenges, particularly when you're still developing your clinical experience.
Bethany: “I think one of the biggest challenges I have come across is not always knowing the right things to do straight away, due to how quickly a patient could deteriorate! It is also really good having a multidisciplinary team (MDT) around for any questions, support and guidance.
I enjoy doing tracheostomy decannulations, which is an advanced skill a rotation band 5 gets to complete.”
Jemma also highlights the importance of colleagues and the wider multidisciplinary team when navigating the more difficult aspects of intensive care.
Jemma: “Our patients are often very weak, experience prolonged and severe delirium, and have multiple, life-sustaining attachments, so it requires specific risk assessment and handling skills.
The trajectory of critical illness and its potential sequalae vary significantly, which, of course, results in some emotionally difficult cases. I am surrounded by a hugely supportive multidisciplinary team and a wonderful group of colleagues that I am lucky to call friends to lean on in these circumstances.”
The moments you never forget
Jemma: “I supported a patient who had a lengthy and tumultuous time in ICU, but made huge strides in their recovery to the point that we focused our rehabilitation goals on high-level, dynamic balance. To do this, we played football up and down the corridors of our unit; a moment of incredible lightness and laughter for them, their family, and the MDT involved in their care. My role in all cases is to support recovery from the physical, emotional, and psychological impact of critical illness. But for this patient, the power of our therapeutic alliance could not be understated.”
Bethany: “One story that has stayed with me is from when I was part of a physio team that stood a patient for the first time following their cardiac arrest. This was very rewarding! A few days later, I was given the opportunity to decannulate their tracheostomy. This was something I was quite nervous about at the time but with support from my team, I was able to successfully complete this. I will never forget that moment.”
Looking beyond intensive care
For Jemma, the opportunity to support patients beyond their ICU admission has given her a valuable perspective on recovery.
Jemma: “Acute Occupational Therapy practice is largely focused on facilitating transition away from hospital back into the community. This means my ward colleagues play a vital role in comprehensive, patient-centred discharge planning after a period of assessment and rehabilitation, enabling patients to leave hospital and recover in their own environments.”
Jemma: “I am also fortunate to work in our follow-up clinic, so I get to hear the stories of our patients after they have left hospital. Witnessing their resilience, determination and strength, as well as that of their loved ones in adapting to life beyond hospital has changed every aspect of my practice and what I hope to teach junior therapists.”
Bethany reflects on how her time in ICU has helped her develop professionally.
Bethany: “Since starting on ICU, my clinical reasoning and ability to think quickly have improved significantly based on the complexity and fast-paced environment.
I would say to anyone considering a career in ICU physiotherapy to just go for it! ICU may sound scary at first, but it is one of the best places to learn and work amongst the MDT.”
Jemma: “Seeing patients progress from being nursed in bed requiring invasive life support to returning to the activities and roles which give them joy and purpose is something from which I will never tire.
I will always be grateful to my patients for their frankness and openness in sharing their journeys with me. I have been bettered as a clinician in some way by each one of them.
Part of something bigger
Jemma and Bethany's experiences show just how much can be gained from working alongside people with different skills, perspectives and experiences.
At the Intensive Care Society, we bring professionals together to connect, share knowledge and learn from one another.
Through ICS membership, you can be part of those conversations, access opportunities to develop and help shape the future of intensive care.
Be part of the conversation
In Conversation With is an Intensive Care Society series sharing the stories, experiences and perspectives of people across the intensive care community. From different professions and career stages to the connections that shape patient care, we're exploring the people behind intensive care.
Have a story to share?
Whether you're an intensive care professional, a patient or a family member, we'd love to hear from you. From career journeys and professional experiences to the moments that have stayed with you, every perspective has a place in the conversation.
If you'd like to share your story, get in touch with our Communications team: communicationsteam@ics.ac.uk
