New ICU nurse, feeling depressed

[nicegreen99, BSN, RN]

Hi everyone! This is my first time on here. my counselor suggested I find a nursing support community or group. I've been a nurse for 4 years and recently moved to the ICU from General Cardiac. When I was working cardiac I felt like I was helping people and they were getting better which is why I started nursing in the first place. I was excited to move to ICU to learn new things and new skills. Well after 6 months there I just feel sad. All of my patients die. I don't know if this is a COVID thing or if ICU has always been like this. I feel like a hospice nurse. I don't want to move back to cardiac because I am learning a lot and getting to do a lot of new things that I love, I just hate having to watch my patients die all the time and having to tell their family that they are gone. I find myself grieving them when I get home and feeling overwhelmed. Any advice or kind words?

[JBMmom, MSN, NP]

First off, glad to see that you are making your mental health a priority and working with a counselor. It's a tough time to make the transition and you're NOT alone is dealing with this situation.  

I understand how you feel! The past two years in critical care have been awful. In November, December and January I think I had a total of two patients that survived. Everyone else died. I think there are currently many factors leading to sicker patients than we've ever seen. One is COVID itself, because I think that while the overall mortality rate isn't very high, once a patient is sick enough that they require critical care they're very likely to die. Our survival rate for intubated COVID patients has to be less than 15%, and that's tough.

COVID has also caused some changes in non-COVID patients that I think has given us sicker patients. The initial isolation of the pandemic and people dealing with job loss gave us a period of patients dealing with issues like alcoholism and substance abuse and we have lost patients to these challenging issues.

Patients with chronic health issues have also been unable to get the care that they needed throughout the pandemic so we're seeing sicker patients with exacerbations of ongoing conditions as well.

In my critical care unit, in the past six weeks we're finally caring for patients that are being discharged other than to the morgue. I'm hoping that we're turning the bend, (and trying to ignore the news stories about another variant making its way around), and I hope that your area starts to see a similar improvement in overall patient prognoses. Critical care hasn't always been like this. You are gaining valuable skills and I hope that your experience improves soon as well.

And I'm not sure whether it's a good thing or not, but over the years I have found a balance where I do feel I'm able to care about the well-being of my patients and truly advocate for them the best I can when I am there, but when I leave, I don't think about them. I find some of my favorite music, or an uplifting podcast, and I listen in the car on my way home. I give myself permission on my ride home, if necessary, to sit in quiet and decompress after the particularly difficult shifts, but when I get to my driveway I'm not in nurse mode anymore, I'm mom-wife-friend-person until I head back to work again. 

Good luck. Things are tough now, but they'll get better. Critical care is a great place to work and your patients will be lucky to have you there. Take care of yourself. And welcome to the board!

[Okami_CCRN, BSN, RN]

I think JBMmom gave you some great insight into what is currently happening in critical care across the country, as well as solid advice to promote mental health.

I want to echo the importance of decompressing, especially after difficult shifts and finding comfort in the fact that the shift is over and you can hang your nurse hat up for a bit.

I also encourage you to find a healthy work/life balance; if you do not feel you can be part of a committee or work on quality initiatives don't feel pressured. I resigned from two committees about a year ago to focus on myself. I just recently rejoined one because I felt I could devote the time and energy to it. 

I really do wish you the best, and hope you find comfort in some of the advice provided. 

[xbananachipsx, BSN, RN]

I've never worked in critical care, but you're definitely experiencing burnout/compassion fatigue.

I commend and appreciate you so much for being at the forefront caring for the thousands of people that need people like you.

your mental health is a priority. if you feel like it's difficult to focus on the job - or even consistently dread going to work, definitely reach out to a therapist - which sounds like you are. you might consider meds to work through your anxiety.

take some time off if you have to - if you have a doctor's note to go on leave, that's definitely protect you and your employers has to honor that. you have a big heart, but don't lose it. 

feel free to e-mail me if you have any questions/need more insight on mental health as I'm a psych nurse. [email protected]

[HiddenAngels]

You're a wonderful human for opening up to family members with your emotions re: their love ones passing.  Stay strong. When people lose a family member they do experience  a tremendous amount of shock, but once the shock wears off they remember how much care and concern you showed them by your outward expressions of empathy.  With that being said, you do have to make peace and leave it at work.. 

[nicegreen99, BSN, RN]

Thank you everyone for all the support! I didn't really anticipate anyone even replying to me so thank you! I appreciate the explanations and helpful advice so much. It has just been difficult dealing with death as well as all the new things you learn in critical care, not to mention I'm going through a divorce with someone who blames my job for the divorce ? (not the reason.) It has all been so hard and I'm glad I found this community!

[anonymous_5591]

Critical care is grim. 

It took me a few months to realize the significance of my boss' first words to me during our interview which was, "You're the funeral attendant". Out of everything on my resume (I was a nurse already for a year) this was the thing that stood out the most to her and made an impression. 

Working in a funeral home for 6 years taught me a lot about death and dying and dealing with grief. These lessons took me 6 years of working in the funeral industry to understand and I honestly don't know where I would be without that background. One of the best words of advice I have received is that, "their grief is not yours to bear". It sounds heartless but it's true. You can show compassion by being present and listening but it's important to remember that unfortunately life is not guaranteed. I remind myself of this everyday, and try to live my life to the absolute fullest. (that's how I cope). 

 

To quote one of my favorite shows Six Feet Under, "Nate: “Everybody dies. Some of us live to be 100, some never make it through the first day." It's heartbreaking, but once you accept this I find it makes things less depressing. 

I recommend watching the show.   --Also, please remember that the hospital setting is the worst of it. People are grieving the loss of that relationship, or the loss of broken/unfulfilled promises, once this passes generally during the funeral people celebrate the life of that person.