MICURN6339

Hello all, my name is Jordan, and I am an RN, and I want to share with you all some of what I do in my role as an ICU nurse. A little background… I have been a nurse for three years, in which time I have learned a tremendous amount about myself and so many other people. When deciding what I wanted to do for work after high school and college, I always admired nurses for their hard work in providing for their families while also doing so much for people they had never met before. I knew that I also liked the flexibility of the schedule, knowing I would have children later on in life. Although I did know that nursing would never make me rich, I felt like it was still a great profession to go into, and I decided that this is what I wanted to do. Prior to becoming a nurse, I was a CNA for about two years on an orthopedic unit, which I would later learn is probably the busiest floor out there. This job helped me appreciate the hard work that ortho and surgical nurses go through while also helping me decide that this was not a unit that I was interested in working on. So naturally, I decided to take a new grad position on easily the second most busy unit out there, neuroscience telemetry (NSTU). With 28 beds and constant staffing issues, I learned an immense amount in my first year out of nursing school. Teamwork, humility, and time management were key in that year I spent on NSTU, and while it was a whirlwind of mandatory on-call shifts and losing sleep working night shift, it never once steered me away from my passion to be a nurse and care for patients and their family members. After a year on NSTU, I relocated to another city and decided to move onto another hospital that was a lot closer to home. This move actually placed me working in the medical ICU (MICU) which was a goal position of mine. Starting in the ICU, I quickly learned, was like a new grad year all over again because I was working with a patient population that is extremely vulnerable who relied on the nurses for everything from ADLs to resuscitation of life, to receiving comfort care at the end of life. While I have only been an ICU nurse for two years now, I have learned that I do really love being a nurse, and even more, I love working at the bedside. So, what does an ICU nurse do? A fairly standard nurse to patient ratio for an ICU nurse is one to two patients, depending on their acuity level at that time. However, as of lately, there is a basic expectation of having two to three patients to take care of for the night. Working on the floor, I had as many as five patients a night, so two or three doesn’t seem too bad at first. I learned quickly that these patients are completely different because they are at the highest level of care in the hospital, the intensive care unit. While you never really know what your patients will be for the night, you can expect at least one intubated patient (which entails many moving parts in terms of care), a patient that requires ICU level drips (like vasopressors, or even just precede to get them through the window of alcohol withdrawal), and maybe an admission from the ED (which could be anywhere from a cardiac arrest to a DKA patient—two patients that vary significantly in intensity of care). Many of these patients have as many as 6-7 titratable drips going at once that require constant reassessment in order to maintain an adequate level of sedation, high enough blood pressure or heart rate, etc. Basically, there are many moving parts going on in each room that are pertinent to life in many of these patients. Even given all of that, three ICU patients can be a very unsafe number of patients for one nurse to take care of, but this is the reality of nursing today. To get through a shift with three ICU patients, it takes experience, close care, and the help of coworkers to safely manage these patients’ care. While you may have an expectation of what you will walk into when working in the ICU, you really never know what it will end up as. The most seemingly stable of patients can crash right before your eyes, and it takes accurate careful assessment to notice the small changes in patients to avoid them crashing. This leaves a lot of pressure on the nurses because there is a tremendous amount of autonomy involved in ICU nursing. We rely a lot on the experience and education we have, but a lot of times, we rely on our ‘gut’ instincts in instances where we feel like a patient is declining. Just like any other nurse, we have to express our concerns to the physicians. Luckily as an ICU nurse, this is a lot easier than it is out on the floor, as there are intensivists or pulmonologists, and/or mid-level physicians on the unit all night. I have found that this helps with the nurse-physician relationship because the physicians get to know you fairly well and are often more receptive to hearing concerns. While these relationships can help, some doctors still do not always feel the same ‘gut’ instincts that a nurse might, and, ultimately, it is their decision whether or not they would like to proceed with any further meds, testing, etc. Just like anywhere else, we have to chart, chart, chart. Probably the hardest part of ICU that I have found is working with and supporting family members throughout a patient’s ICU stay. I can imagine how scary it is to hear that a family member has ended up in the ICU as a patient because, oftentimes, this means that the patient would die without receiving this level of care. Many of these patients have recently suffered cardiac arrests, have recently been intubated, discovered unresponsive at home, been in a car accident, or even have just had a gradual decline in status. As you can imagine, these are difficult things to grasp for families, and it is up to the nurses to help support these family members through these difficult times. I have personally spent over 30 minutes on the phone with a family member, just to have two more family members call that can require just as much time. This time spent is immensely important to the overall care for the patient because these conversations could lead to pertinent changes in care like a DNR order or withdrawal of care on a patient who has been slowly fading. While these conversations are important, this is also something that ultimately takes away from the care being provided to patients because that is time spent away from them. To summarize… Although what I have shared is such a small glimpse of ICU nursing, I hope it sheds some light on some of the struggles that I have dealt with in my time in this role. As an ICU nurse, there is an immense amount on our shoulders in one shift, and I truly feel like some days I am keeping people alive with every move I make. This really can take a toll on your mental health, and I have found that I rely on my coworkers to get me through some of these struggles. The worst nights are when you give everything you have to a patient and they still pass away. What is even weirder is that you have to turn around and care for your other patient as if nothing happened. It is all a strange, twisted reality. I have had situations that make me want to give up and quit my job because I am burnt out and frustrated with the situations I am put in by doctors when they don’t listen to my pleas for my patients. When it comes down to it, it is my patients who keep me coming back. I love the care that I can provide for my patients, and I feel like I am making a difference in both their lives as well as their families' lives. As long as I can continue to say this, I know that I will always feel fulfilled in my role.