Want to swap to ICU but I cry during codes

  1. I'm currently working on an ortho floor at just over 1 year into nursing and am ready for a change. I love my ortho patients but we're just too short-staffed for me to properly care for them, and my manager is never going to grow a backbone and fight to change that. I'm burned out.

    I'd like to go to ICU, but as you can imagine, I feel pretty underprepared. I've bought The ICU Book and I'm going to study up on all the things I know that I'll need to know in ICU that I don't use now, and I have every confidence that I'll do great with the learning. The only thing I dread is becoming overly emotional.

    I've had several patients die on me, but never while I was there. I was sad for them, but never felt like crying or anything. Then one night, a patient coded. It wasn't my patient, but the code was pretty awful as far as codes go. It was super unexpected, it lasted nearly an hour, and the patient's children were nurses in the hospital so they were called from their departments. They stood outside the room to let the code team work, sobbing and screaming at the patient to please come back, don't leave them, the entire hour. The patient did not make it.

    I feel myself tearing up every time I even think about it. Whenever I hear a code called now, I immediately feel like crying. I'm the type of person who can't see other people crying without feeling like I want to cry myself. I don't know if I'm strong enough emotionally to work in ICU and keep the distance I'd need to keep in order to be a strong supporter of families in their time of need instead of just another person crying. I don't know how I could possibly do chest compressions on all these little old ladies who are full codes that we get on ortho all the time. I'd feel so horrible doing it. It's not right, but that would be my job.

    In short, I just don't know if ICU is right for me. I feel like I care too much and have too much empathy for it. I'm scared of it sticking with me, of taking it home with me. I already know I could never work with babies or children because of this. Any guidance would be appreciated, because my brain is like "Yes, ICU = growth and knowledge!" but my emotions tell me to stay away.
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  2. 24 Comments

  3. by   kp1987
    Considering you'll probably go to codes and have many codes in ICU it might be too emotional for you. Obviously there's always times when situations get to you or you've built a relationship with a patient and they pass but as you seem like a sensitive person id probably find a more stable area to move too

    Good luck
  4. by   Aromatic
    usually patient's code in the ICU. if you want a change you could try ER. there are actually less codes in the ER it seems than the ICU, of course variable in regards to hospital location and size.
  5. by   ProgressiveThinking
    If you can't stand codes, don't work in critical care. Stay away from ICU and ED. This is where patients code, and a lot of the time you learn the most from patients that require you to bust your hump all night in order to keep them alive and then end up coding anyways... Go work in psych, OB, dialysis, or anywhere but ICU or ED.
  6. by   Sun0408
    If you can't handle codes, don't do it. Codes don't bother me but the pts that are rotting from inside out, or outside in. Laying in the bed crying, on the vent, pressure to soft to medicate are the problem. Families that want everything done while mom sits in the ICU alone with the most horrific skin, wounds etc. That's the part about ICU that can get to you. One thing I have learned in the years of being a ICU nurse is... There are worse things then death!!
  7. by   Julius Seizure
    Quote from Sun0408
    One thing I have learned in the years of being a ICU nurse is... There are worse things then death!!

    True.

    This may take some real soul searching on your part, about if you are willing to give ICU a chance or think you can swing it. Theres a possibility that once you become accustomed to the ICU environment, you will see codes differently and emotionally handle them better. Perhaps the reason that they affect you more on the floor is that people aren't "supposed" to code on the floor. In ICU, we often see it coming, at least as a possibility, and as the other poster said....there are worse fates. Sometimes death is a relief.

    I have, on the other hand seen nurses train to the ICU only to leave again because they found it too emotionally taxing. It's okay if thats you....but you may never know unless you try.
  8. by   CranberryMuffin
    You will be responsible for going to codes. AND you will have very sick and complicated patients - sometimes i found that caring for these patients was more stressful than being in a code because you can be in a situation where you are trying to prevent them from coding for your entire shift.

    There are two sides to this:
    1. Getting experience in the ICU and more exposure to codes might "toughen" you up. Over time you might become less sensitive and able to handle codes and other stressful experiences more nonchalantly.

    2. You could become overly stressed and anxious about it and over time that takes a toll on someone. This was the case for me. I developed an anxiety disorder. I am pretty sure I have PTSD from working in the ICU. To this day I cringe when I hear a ventilator alarm going off and I get all anxious when I see people running to a code. My body has a physiological reaction when I'm on the ICU floor (even though I work in administration now).

    I agree with the above comment that there are worse things than death. Over time this and the stress is what made me leave the ICU.

    If you just want a change, there are so many other things you can do. If you want to get more acclimated to codes, you could also try to get on the code committee for your hospital. If you are not sure about the ICU, ask to shadow an ICU nurse for a few shifts to see how it feels.

    ICU = growth and knowledge. All areas of nursing = growth and knowledge. I can guarantee you that most ICU nurses don't know much about OB nursing or OR nursing or psych nursing unless they have had direct experience in that field. Don't look at it as a weakness if you decide to go another route. We all have different strengths that we bring to nursing.
  9. by   Nalon1 RN/EMT-P
    Quote from Aromatic
    usually patient's code in the ICU. if you want a change you could try ER. there are actually less codes in the ER it seems than the ICU, of course variable in regards to hospital location and size.
    So out of the frying pan into the fire?
    Don't know about where you work, but the smaller ER where I am has 10-12 codes per week (sometimes more).
    There is a Code Blue somewhere in the 200 bed hospital (including the ICU, but not the ER) maybe daily, so a lot less codes in our ICU.

    Now with the ER, there is usually no previous patient relationship (occasionally we get a code of a frequent flier, but not often), so you don't have that part of the problem, but there can be a lot of drama, yelling and crying by family members.

    I have to agree with other posters though, If you can't stay composed during a code, you may need to either stay where you are or find another area that has a low probability of codes.
    Now if you can stay composed during the code and are then cry later, many do that, bit it can take a lot out of you if it happens a lot.
  10. by   heystargirl
    I don't think you should rule out working in ICU as a possibility, but I think you should talk to someone about your feelings regarding the code situation you mentioned. As nurses, we do grieve alongside our patients and their families, and it sounds like you're still dealing with some of those feelings. You seem like a very caring, compassionate person, and I think you'll be just fine as an ICU nurse after you take a little time to process through your feelings with a trained professional. Hang in there.
  11. by   Aliareza
    Thank you all for the insight and input. I didn't see that last reply about processing my feelings until just now, but that's what I think I've needed to do all along. I've spent the past few days just thinking over why I'm a nurse, what I love about it, what I hate about it, and how all of that ties into codes, death, and the ICU.

    The conclusion I came to is that I'm more coldly clinical than I realized, and that I love this job because I'm a problem solver. I don't really care to know about the little old lady in front of me, her grandkids, her garden, etc. I'm kind, but I'm not there to befriend her. I'm there to help her solve her medical problem. There's nothing I love more than educating patients, because it's like long-term problem solving.

    I think the reason I got stuck on the bad feelings from that code was because it wasn't my patient and I couldn't help with the code. All I had was the awful emotional aspect of it to focus on. Despite that, I didn't cry when it happened. I knew the nurse who had that patient wouldn't be able to give his meds for that hour because he'd be busy, so I stepped in and helped with his patients.

    It'll always be heartwrenching hearing somebody grieve as they lose their loved one, but I'm now pretty sure that when it's my job to intervene, I will be able to do it. I'm not afraid of death, but I want people to have dignified deaths. I very well may not find my forever home on the ICU floor simply because I fully agree there are many worse things than death and I know I'll see them in the ICU. But I know right now I want to try, and so try I shall.
  12. by   OrganizedChaos
    If you can't seem to separate yourself from a code I would suggest seeing a therapist. It could help you sort your feelings out.
  13. by   canoehead
    My first code could bring me to tears even a year later if I thought about it. Look at me now, official Crusty Old Bat member. I was too new as a nurse, and not confident in my skills, and too young in general life experience. If you find a code upsetting now, that doesn't mean you'll never make an ICU nurse. I do think transferring to ICU is extremely stressful, and the emotional aspect could make it hard for you to digest the technical learning. My vote would be to wait a year, maybe transfer within the hospital to a cardiac floor, so you're learning information that will give you a leg up. A low acuity ICU, with rare vents, might be doable, but they are scarce, and not as intense as a usual ICU experience. Get your ACLS ASAP, it will give you a bit more perspective.
  14. by   Ruby Vee
    I'm sure you're going to get a plethora of responses about whether or not you should transfer to ICU given your emotional challenges. I think the bigger question is have you been at your current job long enough to become expert AND long enough to give the manager who hired you some return on her investment? And the answer to both is no. It takes approximately two years to become expert as a nurse or in a nursing job, and it takes that long to give your manager a return on her investment. My advice is to stay where you are and put in your two years.

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