Highs and Lows ICU style

Cuddleswithpuddles · Jun 30, 2014

I fit the bill. End of July will mark my first year in ICU, and I have worked in step-down, home health, postpartum, newborn nursery and floated to a bunch of other units.

What do you mean by highs and lows? Do you mean emotional highs and lows, fast or slow periods during the day..?

FarminRN · Jun 30, 2014

I think aspects of your jobs that you really like and aspects of your job that you could do with out. It can be emotional not so much slow and fast periods unless you LOVE the fast and slow pace switch up...

palaviccinim · Jul 3, 2014

Hi! I am a new-ish grad (2 years out of school) with 1 year of med surg experience and am about to hit 1 year of Neuro Intensive Care Nursing.. my highs and lows obviously vary greatly depending on the situation (brand new trauma admit often has more lows than highs, but other days i take care of patients who are close to outpatient rehab centers, etc., which often bring more highs).

Here are the highs and lows of my most recent shifts:

Highs - a gracious family who appreciated my weak attempts to speak spanish in order to communicate with them :) It's embarassing but helpful!, A family who brought homemade ceviche as a thank you for taking care of their 15 yr old girl, identifying a key but subtle neurological change in a patient that prevented further complications.

Lows - poop. all the poop. SO MUCH POOP. and doctors who want things done right away, even though they've just placed new orders on both of your patients at the same time.

Neutrals - lab draws, taking patients to CT/MRI, IV Starts, dressing changes, etc.

I will say that when I first started in ICU I thought everything would be adrenaline pumping madness... In reality, there are definitely some adrenaline pumping moments (yesterday a patient vomited almost 1 liter of blood all over his bed for no apparent reason, then proceeded to aspirate on the blood and was emergently intubated)... but by and large, my days are "assess, turn, clean, feed, meds, repeat." :) Lots more things ot monitor, but not everyone is CRITICALLY critical. :)

calivianya, BSN, RN · Jul 5, 2014

Lows: Watching physicians obviously do things just to avoid being sued that aren't practical and don't help anybody. There's a confused end-stage Alzheimer's patient who decided not to grip someone's hand? Let's give her tPA and expensive CT scans for fun even though she is so far gone that she is nonverbal and cachexic! Watching the specialists tell the family, "Her kidney function is better today!" and ignore the fact that she is in ARDS with an ejection fraction in the toilet, and then the family is surprised when the patient dies because "Dr. So-and-so stated she was better!" All of the poop with no CNAs to help clean it up; having to occasionally leave someone sitting in it because we are total care and everyone is busy in their rooms and no one can help you, etc. The overbearing families who live in other parts of the country and never visit their nursing-home-bound relative, but compensate for it by wanting everything done even if it's not appropriate for the patient's condition to be a full code and get up in everyone's business like they are actually concerned about what is going on. Maybe they really are concerned during that one particular week out of the entire year, I don't know. That last one probably happens in any part of the hospital, but it is a pet peeve.

Highs: watching my actions immediately and directly impact the patient, such as near-immediate changes in BP when I initiate a pressor, etc. The teamwork is a high - we are all in each other's business in my ICU. There are a lot of help and a lot of heads to put together to figure out what is going on with the patient. It's pretty rewarding to help a coworker figure something out. Figuring out anything in particular is rewarding - I feel like I have more time in ICU to really know the patient, to really dig through what drugs/interventions we are doing and how it's relevant to the patient condition, and it's a high for me when I realize we are not doing something that we should be, I call a physician, and get that order on board and prevent a complication before it occurs.

Neutral - Patients on insulin drips really get on some of my coworker's nerves, but I don't really have any particular feelings about them.

Cuddleswithpuddles · Jul 8, 2014

calivianya hit on a very, very good point. ICU is where I see the most futile care and the most narrow-minded statements about the patients' conditions. Every day someone makes a breezy, happy statement about the brass and silverware on the Titanic being very, very shiny.

A nearly daily high for me is knowing that someone -

- is clean and a little bit more comfortable or

- has another day to fight or

- passed on with as much dignity as possible

...and that I played a big role in that.

ktliz · Aug 8, 2014

Just about 2 years of experience in the ICU.

Highs..

-Making my patient as comfortable as possible. Whether that means a bath, getting up and sitting in a chair, allowing them a few hours of uninterrupted sleep or providing just the right PRN med.

-When my assignment is busy (like a new admission), but I'm just "in the groove," feeling totally competent and on top of things.

-Wound care. I'm a weirdo... I love assessing wounds and changing dressings.

-Just interacting with my patients and/or their families. I love 98% of the people that I meet in this job. When they acknowledge my hard work and thank me for a job well done... it doesn't get any better than that

-Oh, and I love everyone I work with, too!! From nurses to techs to therapists to doctors, we have a great team.

Lows...

-Like others have said, all the unnecessary and futile care. I HATE having to stick little old ladies and little old men for labs when their arms are already covered in bruises. Or when a patient clearly didn't want intubation/resuscitation/trach/PEG/whatever, but the family insists we "do everything."

-Frequent fliers who refuse to take care of themselves.

-When I have a busy assignment and I just can't seem to get on top of things, and feel like I'm leaving a ton of work for the next shift.

Neutrals

-Assessments, meds, charting. We do "safety huddle" at the beginning of every shift and I'm pretty neutral about that.