Are we doing good for our patients?

[GeologistRN]

Hi everyone,

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.

Any thoughts?

[PMFB-RN, RN]

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.

I suggest you get the text book for Fundamentals of Critical Care Support class. Take the class if you can.

[Dranger]

No sedation on a paralyzed patient? That's akin to to locked-in syndrome. Even with fluid concerns that is unethical...

[Greenclip]

Yep, you nailed it. Its why I always preferred SICU vs MICU. What you have observed is standard across the country in my experience.

Its caused by our awful culture that won't accept death and cowardly physicians who wont be honest

That is exactly right.

[Nellie Nurse]

It's like you are me. I have been working in an ICU for almost a year now. I find myself more bothered with the things that go on here than in any other place I have worked. Having to participate in caring for patients who are rotting away in the bed because the family cannot let go is so stressful for me. I have the suspicion that at times the motivation to keep grandma alive for a little longer is to continue to collect their checks. That makes it extra disturbing. I also find it really upsetting that a family member can disregard a patient's signed DNR just because they can no longer speak for themselves. It seems like we do more and more and more tests, procedures, etc with the same outcome at the end but adding extra pain and distress. Like you, I don't think that I can do this work for much longer. I feel not quite depressed but definitely more melancholy after working and it takes me several days to feels more like myself. I took some much needed PTO over the holiday just to get away from work.

I have learned a lot from this job and for that I am grateful but I really do not want to participate in this aspect of medicine anymore.