Are the pts in the ICU mostly unconscious?

[Philly85]

Hi everyone...sorry for the strange question in advance (though I've definitely seen some strange ones reading through the archives lately!)

Anyway, I'm finishing up my last pre-req right now and am about to apply to 2nd degree accelerated BSN programs.

I've been reading this board and giving my career choice a lot of thought lately.

First, I absolutely love the idea of working in the ICU. Focusing on one or two patients with high acuity at a time and knowing absolutely everything about them.

Performing intricate procedures, monitoring, titrations, etc, being able to access my pts quickly/see them from the nurses' station, etc.

I'm very detail oriented and hate doing a lot of unrelated things all at once, so ICU is very appealing to me.

I have soooo much respect for Med/Surg nurses, but I know that I would never survive in that environment long-term. I feel like I would hate it. Being pulled in a million directions, taking care of between 5-8 patients at once...I would get so distracted. Mad props to y'all!

Anyway, now that I've prattled on, I do have one question for you ICU'ers out there.

Would you say that the majority of your patients are unconscious or only semi-conscious for the majority of their stay before they get transferred out?

I don't mean to say this in the wrong way but, if so, do you find that you kind of appreciate that fact?

Obviously, I would absolutely want my patients to get better asap, but I feel like it might be nice to be able to just go about your work, not having to worry about getting sucked into conversation or being embarrassed by performing intimate care, etc.

Just being able to focus on providing amazing clinical care without interruption.

I understand that a lot of the times, the pt's family/friends are there, so you are still constantly updating/teaching, etc, but on nights, that wouldn't be an issue.

I love interacting with people most of the times and I know that as a professional, I will need to get over the "embarrassment" of performing intimate care (I'm male, so I guess I just have a bit of anxiety about the female patients), but it seems like it might be kind of nice. Obviously, when they would start to wake up/get better, you would have that interaction, which I think would be nice, as well. Kind of a nice mix of both.

Conversely, do some of you find that you don't like it b/c you can't get any response from the pt and they aren't able to communicate what is wrong? Also, I would imagine providing personal care is much more difficult, since they can't assist in moving themselves around, etc.

I'm interested to hear everyone's thoughts!

Thanks in advance!

[JustBeachyNurse, LPN]

Have you ever been in or visited an ICU? Not everyone is unconscious and patients are even discharged right from the ICU. There are MANY nonverbal ways to communicate. You have a lot to learn as a prenursing student.

[needlesmcgeeRN, ASN, RN]

Have you considered a career in Mortuary Sciences?

[BeatsPerMinute, BSN, RN]

Hmmm I would say that about 1/3 of my patients on a vent, and 95% of the time you can bet they are knocked out. I've had a few who have been on minimal to no sedation managed by pain meds only, and they were able to follow commands/blink/nod/ write to communicate.

Don't feel bad about this question. Lets be real. The ICU nurses, myself included, prefer sedated patients. A sedated/vented patient is easier to care for since they're not constantly drilling you with questions or insulting you. My unit does an amazing job caring for any patient, but we all do a happy dance when are assignment is 2 vented/sedated patients.

Be prepared though that you WILL be pulled in multiple directions despite having fewer patients. You condense the cares of 5-8 patients into 1-3 because ICU patients are very sick.

As for the embarrassment of providing "intimate care".... you get over that quickly. I work on a cardiac ICU and I have more male than female patients, and simply explain "I'm going to clean your foley / peri area now" before pulling up their gown. Females are more nervous than males, but if you exert that professional attitude/ confidence, they usually don't comment and just let you do your job. They know it is your job to keep them clean and infection free.

Good luck, and feel free to PM me with questions. The ICU is a fun ride.

[VANurse2010]

It depends on the type and acuity of the particular ICU. MICU - you're going to see a lot of intubated patients with some degree or another of sedation. Surgical and cardiac ICUs - more quick extubations. Neuro - lots of intubated *and* lightly sedated patients - lots of self-extubations.

EBP favors less use of sedation - especially propofol and benzos. Just in my 2 years of ICU nursing, I've seen fewer and fewer KO'd patients on a vent.

[LV3677]

My favorite answer: It depends.

Get comfortable with initiating conversation both with patients and their families as well as doing peri care and other personal cares.

[VANurse2010]

My favorite answer: It depends.

Get comfortable with initiating conversation both with patients and their families as well as doing peri care and other personal cares.

Yep. I do way more 'basic care" now than I ever did as a floor nurse.

[Philly85]

Thanks BeatsPerMinute & VANurse2010 for your helpful, informative replies.

To the others who responded, I want to make it clear that I would have no problem with conscious patients and performing personal care. I know that it is part of the job and actually am looking forward to it, since I believe I will actually enjoy being able to provide comfort and relief to someone who is feeling so vulnerable.

Yes, I have been in an ICU a few times before. No, I have not shadowed in one. In my experience, most of the patients were unconscious. I was merely asking a simple question out of curiosity to get a better feel.

And I know there are more ways to communicate than verbally, but I was referencing full alertness/speech, which would obviously slow you down more at times.

As far as being pulled in a lot of directions, I know that I'm not going to be able to be 100% single-minded, that's not what I was expecting, of course, but I'd still rather be pulled in a bunch of directions for things all related to each other for 1 or 2 patients, not a 100 unrelated things b/c I have too many patients.

And I know I have a lot to learn. Why do you think I asked in the first place?

Again, thanks to those who understood where I was coming from and actually provided helpful feedback.

[Lev, MSN, RN, NP]

ER perspective here: probably about 30% maybe 40% of the patients we send up to the ICU are vented. But, I think the answer is really institution specific and probably specialty ICU specific and how critical the ICUs are. ICU patients in one hospital may be step-down patients in a different ICU.

[NickiLaughs, ADN, BSN, RN]

Some are, some aren't and you will get pulled a lot for things completely unrelated as well as to your patients. You will get phone calls, you will have unhappy families, you will have altered patients that you spend the whole night trying to keep in the bed. Another nurse's patient will code and you will rush to help with that.

There will be nights where everything goes right and others where everything goes wrong. I have had nights where I didn't get to chart a thing until an hour before my shift was over.

I thought I was going to be an ICU nurse for life, I did it for 3 years, and while I loved some of the detail and sick patients and the many skills I acquired, managing multiple drips, managing machines like arctic sun and CRRT. I grew tired of having the same patients sometimes for months. The monotony of knowing everything sort of burnt me out. Mostly my patients were very sick and probably should have been comfort care much sooner than they were. If you are primary nurse for a sick patient with a very demanding family, you can have to encounter this family for potentially months every shift. For these reasons, I switched to ER. My skills are still pretty useful (mainly drips and vents). I run to the sick patients with joy, knowing that by the end of shift they will be in the hands of a very capable ICU nurse who loved it more than I did.

The beauty of nursing school is you will have the opportunity to encounter every department and experience what you enjoy. Had I been more honest with myself, I would have gone to ER from the beginning.

The nice thing is, you have time.

Good luck in your future career.

[NurseGirl525, ASN, RN]

I think it also depends on what type of icu you are looking for. In some icu units, the nurses perform every bit of care so having 2 patients is a lot. Other units may have a tech to assist. There is a huge difference in having icu patients over medsurg patients. And while yes having 5 patients on a medsurg unit is very busy, 2 patients on an icu unit is comparable. A neuro icu unit may have more sedated patients. There are all kinds of different icu units, but generally, they are a mixture. It also depends on how high acuity the hospital is. A bigger city hospital will have higher acuity and generally more sedated patients than a rural hospital icu that kind of lumps things together.

[Creamsoda, ASN, RN]

Id say its about half and half. I mean you have a broad spectrum of patients, and before you transfer out to a regular floor theoretically you are more awake and more coherent. Still alot of delerium too, but most people are on the mend to some degree before they transfer out. So you get your super sick, new admit, sedated and ventilated, all the way to our post op open hearts who are starting to ambulate, low dose drips, etc.