ICU Nurse opinions

Dinith88 · Jan 11, 2009

Hi All!
I have seen many patients in ICU who are on vents and very unlikely to improve. My question is, do you ever feel as though your causing them more harm by lengthening their life? Such as having severe pain and on a vent, but because they are full code so you have to take every measure to maintain their life? So, as nurses, how do you deal with this?
I guess i'm worried because I have sort of a "hospice" view, and am worried that I will burn out fast if I go work in an ICU. I love taking the best care I can of my patients, regardless of their personal desires.
Thank you!

Yes you will see lots of unfortunate situations like that. And yes because of your (our) self-appointed moral high-ground you'll rant and yell about it...to yourself and to others and to the gods..and... You just have push ahead. All ICU nurses (at least all the good ones :) ) are affected by it. Will it run you out of the Unit? Maybe. It does alot of folks. But... We have to do our jobs...and what the family wants.

Also...the ICU corpses on life support are FAR different from the hospice experience many of us are familiar with. In ICU the families are freshly in shock, in crisis, in anger, helpless,..(and all the other stages of grieving, etc). You have to sit with them, council them, dodge their punches, etc...When this process nears completion and they're accepting...then it becomes more of a hospice-type experience...

AND...thats just ONE of the cultural/moral/existential/alcoholism-inducing aspects of the ICU...to say nothing of the work...and it's just the tip of the iceburg.

**NickiLaughs, ADN, BSN, RN** · Jan 11, 2009

Thank you I really appreciate that. It really enlightened me as to the psychological aspect of critical care nursing. I guess I didn't get enough of a chance in nursing school to see whether ICU suits me for certain or not. I did like it though.

Thank you!

debgirl71 · Jan 12, 2009

we have less of an issue with pain control and sedation in the unit where i work because most of our residents order a nurse driven protocol that we use. we have one private physician with frequent, chronic long term patients who admits to our unit and doesn't like sedation for his patients, but will order usually adequate pain control. if not, sometimes frequent updates :chuckle are necessary to remind this physician that his patient's pain is not controlled. we monitor and document every four hours sedation and agitation for all patients, not just the vented ones. we do cluster care for our "sensitive" patients who cannot tolerate sedation for whatever reason (and for the neuro patients). we try to decrease stimulation, especially at night.

RNFELICITY · Jan 14, 2009

I think that as long as you have a heart, these things will get to you. I try to de-brief with fellow nurses on the unit, cry on the way home, come here to vent with others or call my hubby...lol.

Sometimes these things make us examine our values and how we want to live our life.

I think burn out/stress is a real factor for us and sometimes you just have to change up your assignments. i knoew that I tend to always get the patients that we are about to withdraw care on or are about to die because people think I am good at it. Some times, I have to speak up and say that I need someone who might live this time. It is ok to be vocal.

We have to protect our own well-being too!

My_brain_hurts · Jan 25, 2009

I think sometimes what we do in the ICU -prolonging life when if it were my pet I'd have put them down long ago, or multiple codes when you know the pt is less likely to survive after each one and you just want to let them go and be at peace-- sometimes I think we do it for the family. I don't know if that's right/wrong/good/bad, that's just what seems to happen. Sometimes a pt will be full code all shift long, and after multiple interventions, codes, etc. the family will decide the next day to make pt DNR.

Nursing isn't just about the pt, it's sometimes about the pt's family also. I think sometimes people just need to know they didn't give up on their loved one. I don't know. It can be a mess sometimes. If it's any comfort, I think a lot of the really sick pt's are 'already gone' if you know what I mean, or at least I hope they are or hope they don't remember what went on the last few days.

yeSICU · Jan 27, 2009

I often question whether I am prolonging life or prolonging suffering. The solution to my frustrations is to go to grad school and get into an area of nursing where I don't get so attached to my patients, and for the most part will deal with healthy people. I found myself getting too upset when my cute 90 y.o LOL (little old lady) had her final wishes to pass at home trampled on by families who just don't know any better. You can't blame them, their greiving is just too new. They think only about how they feel, not their loved one. So grandma is a full code, broken ribs and all... it really started to get to me. I am so pleased when families let someone go with grace and dignity. I am ready to move on after 3 years in the ICU, but I wouldn't trade my time there in for the world. I have learned so much about nursing, life, and what it means to love and respect someone. It is truly an awesome experience and I give so much credit to nurses that make it their career. They are truly the unsung heroes.

dorimar, BSN, RN · Jan 28, 2009

It still gets to me after many years... Dinith articulated it very well. I think that the term "Angels of Mercy" has truly become a misnomer with all we do in our care, despite analgesics and sedation. But the minute you stop caring about that, is the minute you should leave.

elizadream · Jan 28, 2009

If it's a sudden cardiac or neuro event, the patient's family needs time to digest and accept the events that are unfolding. But regardless of how YOU feel, it's the family's decision-sometimes there is money involved-a government check maybe, or a family disagreement-but I have found regardless of how YOU, the nurse feels, It doesn't matter, and you are to continue on with what the FAMILY wants.