I am a brand new nurse, went straight into a MICU. I am about 2.5 months in (of a 3 month preceptorship) and struggling on a fundamental level with what this job is: It seems that all we are doing for 90%, perhaps 95% of our patients is prolonging suffering. We add tubes, we poke, we paralyze, we shock them, we wake them at all hours of the night...and for what? So they can die a couple of weeks later than they would have otherwise? A couple of months later? After having endured minimal, if any quality of life? In an unfamiliar environment, no windows, no plants, no sky? The last three shifts were the ones that put me over the edge: pouring blood products and pressors into a guy in DIC, and watching ever more blood pour out of ever more parts of him. And Nimbex, (along with Fentanyl, Versed, and Propofol) into a patient in ARDS with an ever-dropping pH and her daughter there hanging on every word, hoping for a miracle. Right now I am wishing I could give many of my patients and their families a priest's care, not the technologically advanced "care" I give. I would rather sing to them than stick them with needles and paralytics. How do I keep doing a job which, at least at the moment, feels like I do more harm than good? Watching people die in front of you all day (or night) and trying to keep them from dying is really, really difficult. It is excruciatingly painful, it is sad, it is terrifying, it is confusing, and I don't know if I can continue to do it.
See the same issues on the floor, people determined to have procedures, get PEG tubes, get revisions...I particularly remember the phrase "He WILL be trached and you will treat him as if he's 20."
Life ends for many reasons, some will be lucky to have long and happy lives while others are literally robbed of the most basic comforts. It's easy to feel like others are needlessly prolonging the suffering of their family members. Sometimes it truly is the patients and they do not want to give up at any cost. When it gets to me I just remember that my title is "Nurse." That is all I have to do. It's not up to me if families have a hard time letting go or if they want to keep someone on a vent indefinitely. I am just there to nurse them, be that nurse back to health or nurse to their dying day.
There is a tremendous moral struggle, but there's not a professional one.
Specializes in clinic, ortho/neuro, trauma, college.
The Institute of Medicine recently put out a lengthy report entitled "Dying in America." It really does an amazing job highlighting all the ways we disservice critically ill patients. The crux of the issue is communication between caregivers/patients and families and a lack of advanced directives. And I truly think medical schools need to do a much better job educating providers on having those conversations with patients and families. You can be honest without being heartless.
I'm sorry you're at this crossroads right now. Do you feel you can just be "nurse" for a bit more experience, and then move on? Another option is your hospital's ethics committee. There may be a chance to get involved in some meaningful and impactful way beyond the bedside.
That's why I could never work in a MICU. Someone on this board once described it as keeping dead people alive a little longer. If you want to stay in critical care, surgical ICUs aren't quite as bad.
Specializes in Allergy/ENT, Occ Health, LTC/Skilled.
Although not in a hospital, the one and only time I have performed CPR, was on a 80 something year old LTC patient, confined to a bed, in pain all the time, and confused -- who was a full code per her daughter. It really tore me up...doing that to her poor, frail body left me in tears after. I ended up talking it out with a nurse who has 20 years experience on me and I consider a mentor. She kindly asked me what could I do in that situation, refuse? No, I couldn't, it was out of my hands. She is much more spiritual than I but she assured me the patient knew I didn't want to do that to her, that I wanted her to pass peacefully with her daughter holding her hand instead of me pumping her chest. For some reason, even though I am mostly agnostic, the thought comforted me. I hope you find peace and what your path should be, I can't imagine going through that everyday.
One more thing I wanted to add that helped me: My mentor pointed out, although I realize this isn't always the case, that whoever is making these end of life/sustaining life decisions is someone that the patient picked out in (hopefully) the right frame of mind. So they trusted that person enough to make theses choices for them. Whether or not they are doing what they wanted, we will never know unless they live to tell us. So my patient could have very well wanted all life sustaining measures -- it was just my head telling me "who would want that?". But just because I wouldn't want that -- doesn't mean another would choose the opposite no matter how severe their condition.
I work in a MICU, lots of people die in the MICU. That's it. Your premise is correct, people die or go on to live in a rehab/sNF forever after leaving. In ways it can be distressing, but at the end of the day it is just a job.
I am one of those people who can make that separation and compartmentalize what I am doing. Not everyone can and that's okay.
Maybe a switch to outpatient? If you like the ICU, the SICU and CVICU are better options.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Although not in a hospital, the one and only time I have performed CPR, was on a 80 something year old LTC patient, confined to a bed, in pain all the time, and confused -- who was a full code per her daughter. It really tore me up...doing that to her poor, frail body left me in tears after. I ended up talking it out with a nurse who has 20 years experience on me and I consider a mentor. She kindly asked me what could I do in that situation, refuse?
I have refused to code "full code " patients on a number of occasions. The first time I expected to get fired but nobody said anything to me about it.
On those occasions I had reasons to know that coding them was aginst the patient's wishes, but for some reason, usually a family member changing code status after the patient could no longer communicat, they were full code anyway.
I won't code a patient aginst their wishes. I hope it doesn't cost me my job, but I also have to sleep at night and look at myself in the mirror.
The first time I did it the code occurred anyway, but without me. This is kind of a big deal since I am the only permanent member of the code team and the code administrator.
Since then when I have refused to code so did the resident (physician).
Wow, that is really great to hear, reassuring and inspiring. I hit my first refusal to do something yesterday: Attending ordered us to remove Fentanyl and Propofol drip from an ARDS patient artificially paralyzed on Vecuronium. The patient's lungs looked worse and the Attending wanted "unnecessary" fluids stopped. After several rounds with the Resident and Fellow we got the Fentanyl and Propofol orders turned back on (we had enough of both in the room to carry us over til the orders were reinstated). Realized later that neither the Resident nor Fellow wanted to carry out the initial D/C orders, but both were relatively powerless against their boss where we nurses were relatively powerful. Good feeling to think we can do some good, interesting to consider the strange roles we all occupy - advocating as best we can for the fundamental essence of human life. As best we can.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Wow, that is really great to hear, reassuring and inspiring. I hit my first refusal to do something yesterday: Attending ordered us to remove Fentanyl and Propofol drip from an ARDS patient artificially paralyzed on Vecuronium. The patient's lungs looked worse and the Attending wanted "unnecessary" fluids stopped. After several rounds with the Resident and Fellow we got the Fentanyl and Propofol orders turned back on (we had enough of both in the room to carry us over til the orders were reinstated). Realized later that neither the Resident nor Fellow wanted to carry out the initial D/C orders, but both were relatively powerless against their boss where we nurses were relatively powerful. Good feeling to think we can do some good, interesting to consider the strange roles we all occupy - advocating as best we can for the fundamental essence of human life. As best we can.
You were standing on the high ground. What he was ordering is not the standard of care for chemically paralyzed patients.
I cannot believe it is still this bad. I worked ICU 1980's for 5 years. For some reason I thought, assumed, these horrible situations had gone by the wayside, things were getting better? I called our unit torture old people until they die unit.
Wow, that is really great to hear, reassuring and inspiring. I hit my first refusal to do something yesterday: Attending ordered us to remove Fentanyl and Propofol drip from an ARDS patient artificially paralyzed on Vecuronium. The patient's lungs looked worse and the Attending wanted "unnecessary" fluids stopped. After several rounds with the Resident and Fellow we got the Fentanyl and Propofol orders turned back on (we had enough of both in the room to carry us over til the orders were reinstated). Realized later that neither the Resident nor Fellow wanted to carry out the initial D/C orders, but both were relatively powerless against their boss where we nurses were relatively powerful. Good feeling to think we can do some good, interesting to consider the strange roles we all occupy - advocating as best we can for the fundamental essence of human life. As best we can.
They wanted to d/c sedation on a paralyzed patient? I'm glad you stood your ground, and I hope you took that over the ordering physician's head. That's like ICU 101.
Your moral distress is the reason I would never work in a MICU. I'm a SICU nurse now and while we get a little bit of that here and there, the majority of the time I feel like we really are doing good for our patients. Traumas, transplants, major surgical complications... of course, there are exceptions to this, but the majority of our patients are facing acute illness/injury. They were fine, something bad happened, and now we're trying to fix them. Sometimes they die, sometimes they get better, and yes, sometimes their lives are pointlessly prolonged, but I find that to be the minority of cases. I find it very rewarding for the most part.
Beginning of january i begin my sicu journey. 2-3 months of sicu training along with didactic critical care training course. I am going to a level 2 hospital and have been working at a level three. I am crossed-trained in icu at the level 3 hospital and pick up shifts regularly. However, i have been a psychiatric nurse on a full time basis that also works in the er. Any books or online training that anyone can suggest that i study before hitting the floor in a few weeks? Please advise.
chacha82, ADN, BSN
626 Posts
See the same issues on the floor, people determined to have procedures, get PEG tubes, get revisions...I particularly remember the phrase "He WILL be trached and you will treat him as if he's 20."
Life ends for many reasons, some will be lucky to have long and happy lives while others are literally robbed of the most basic comforts. It's easy to feel like others are needlessly prolonging the suffering of their family members. Sometimes it truly is the patients and they do not want to give up at any cost. When it gets to me I just remember that my title is "Nurse." That is all I have to do. It's not up to me if families have a hard time letting go or if they want to keep someone on a vent indefinitely. I am just there to nurse them, be that nurse back to health or nurse to their dying day.
There is a tremendous moral struggle, but there's not a professional one.