CCU BSN RN

If you don't work in an ICU, and you don't have more than 3 years of experience.... You did MORE than I would have expected you to be able to do. You identified that longer pauses/lower HR than previous was an issue, checked the patient's blood pressure and evaluated your patient, and got your charge nurse and notified/got the physician to bedside. Heck, you even put pads/leads on and got the defib and/or code cart and atropine. Believe me, your charge nurse would have wanted to know about the change in your patient's acuity level right away even if you felt like you had it covered. Plenty of nurses I've worked with on telemetry have experienced this and failed to realize it was an issue that required immediate action. Plenty still have not told their charge nurse (me) and made me feel like a real idiot when an RRT is called and I didn't even know anything was going on. Needing a few other people to help out when your patient deteriorates quickly are the reason that we have charge nurses, rapid response, and code teams in the hospital. Even in ICU and with 10 years of experience you won't be able to transcutaneously pace your patient, give atropine, get an EKG, and communicate with the team all by yourself. You just simply don't have 8 hands and 4 brains.

I'm a little concerned about the concept of a hospital that doesn't own a ventilator or Bipap machine, to the point where I'm having trouble getting past being incredulous about that and actually wrapping my head around your issue. How big is your hospital? Do you have operating rooms? What happens when your ER doc does intubate the patient prior to transfer? Do you have to wait until EMS is at bedside to intubate so that they can be placed on the ambulance's vent? Do you just sit there and bag them until EMS shows up to transfer the patient? What if your patient has OSA and is on Bipap every night at home? They either bring their own machine with them or they're out of luck? I literally just have hundreds of questions about this logistical nightmare.

If I actually followed our hospital's 'donning and doffing' guidelines every time I entered a COVID room: 1. We would be out of gowns and gloves 2. My patients would be dead, because their levophed would be paused for the 4-6 minutes it would take me to reach the 'upstream occlusion' alarm. And that's 4-6 minutes if I'm right there and catch it right away. Usually I'm in another of my 4 ICU patient's rooms, and don't notice until their SBP is 50. So yeah. I sanitize my hands. I wear a mask and eyewear at all times while inside of the walls of the hospital. But the rest of the PPE guidelines at my hospital would mean hundreds of deaths, and I'm not willing to do something I feel would be akin to murder just because a hospital administrator teamed up with a hospital lawyer to determine how to avoid legal responsibility. Finally, to clarify, if there are adequate time and resources, and if I'm going in to a room to touch a patient or provide any direct care...of course I'm following our policy to a T. But if each of us wasted 120 gowns a shift for trips into a room that are so short we sometimes hold our breath if we don't have an N-95 nearby...nobody would be happier or safer.

I've been in ICU about 5 years. I'm still anxious about messing up and killing someone. I'm less anxious about it now that I have some experience under my belt, but you're at a difficult level of experience right now. You're getting more competent, which means you can appreciate how many ways in which a simple error could cause irreparable harm. You likely used to only understand about half of these ways. Sometimes ignorance really can be blissful. I find it helpful to remind myself that our unit has a very good spirit of teamwork, and any time your patient becomes more critical and starts alarming to high heaven, bleeding profusely, having life-threatening arrhythmias, etc....you wind up with at least a couple of colleagues coming to see what's going on. And if you've missed something, they're pretty good at asking appropriate questions and rapidly determining what you've overlooked or might have messed up, and then helping you fix it. Also, even though it's not very kind to admit to, I like to remind myself of things my colleagues have messed up before, which often horrify me when I hear about. Because if my colleague bolusing an entire bag of insulin or letting their chest tubes clot off didn't kill the patient....well, patients can be hard to kill sometimes. Even when they're very ill. Your body really WANTS to stay alive. It's full of compensatory mechanisms that allow people to have a heart rate of 30, or a SBP of 60 or a sat of 57% for awhile before they actually croak. That said, sometimes a swift breeze could take your patient out. Finally, if you quit and your colleagues are more short-staffed, mistakes will be made and more people will ultimately have poor outcomes. You WILL ultimately make mistakes, whether you're made aware of them or not. We're all human. Just try not to make the same mistakes multiple times. To recap: 1. Mistakes are human, patients would die without the ICU, you're providing a service with a net positive outcome, even with occasional mistakes. 2. Humans are hard to kill (mostly) 3. A little anxiety is helpful, a lot of anxiety is crippling and deserves therapy and/or meds. 4. An adverse event is very rarely exclusively YOUR fault- there are many members of the healthcare team, as well as the nursing team.

I believe VERY strongly that we'll just be injected walking into work one day. That's probably how we'll find out there is a vaccine, is a surprise needle. And I also think that's the proper choice (mandatory vaccines for health care workers and honestly, for all of the American public). Even if the vaccine is terrible, unless you have a life-threatening allergy to components of the vaccine, it should be mandatory. This disease has been such a strain on our healthcare system and myself and my colleagues personally, as well as on the global economy. I'd like to see a vaccine aerosolized and pumped through the ventilation system at Wal Mart, personally. Any vaccine reactions, no matter how poorly made the vaccine is, will pale in comparison to the death and destruction we're seeing from COVID-19. Also by the time a vaccine is available in mass numbers in the US, it's entirely possible that Trump will no longer be POTUS, just as food for thought. It should be a bipartisan effort to provide for the greater good and prevent hundreds of thousands of deaths.

Things like 'Team Nursing' would work so much better if I'd ever met the members of my 'Team' before I was expected to work on a team with them and appropriately delegate patient care tasks to them while also managing a criminally unsafe ICU assignment with 3-4 intubated, proned, paralyzed patients on multiple pressors. Because I barely had time to ask what unit they came from before I was being pulled in several directions to put out dumpster fires in every single room. If they were given ANY training about where supplies/meds were kept, titrating ICU drips, or if we were able to spend half an hour together so I could in-service them before assuming care of anybody...I could make it work infinitely better. Unfortunately, at least at my institution, there were 2 separate entities: the administrators writing endless policy upgrades on zoom meetings at home, and the nurses trying not to feel like they committed a murder secondary to criminally unsafe staffing. These 2 entities had no contact with one another, and thus no administrators were willing to acknowledge or change policies/procedures based upon how poorly the rollout was going.

Proned patients were always 1:1 before COVID. Paralyzed patients on multiple pressors were always 1:1 before COVID At the beginning of COVID, intubated COVID patients were 1:1 Once we had too many intubated COVID patients to staff at that level, it was basically 'anything goes'. I had up to 4 intubated, proned patients on multiple drips in the COVID ICU for several weeks in a row. They got abysmal care. Many died. We were told to be ready to take 6 COVID ICU patients. We were occasionally provided with untrained nurses from other care areas who were unable to give ICU meds, titrate drips, touch a ventilator, or really do anything terribly useful. The question isn't 'what should the staffing level be?' it's 'how criminally unsafe is my hospital's COVID ICU compared to others?'

I think the fiscally responsible upper middle class who have 6-12 months of emergency savings, little to no debt...will do alright. Unfortunately 'fiscally responsible' is a rare breed in our country, given how few people have a thousand dollars in the bank, have carried balances on credit cards for years, and live paycheck to paycheck, even when they earn a decent living... We're all seeing just how fragile our current infrastructure is, and how quickly things get derailed because of a few weeks of lost productivity. I think that's where everyone is making the flip to politics, because it's hard to talk about our economic infrastructure or any part of our country's infrastructure without being well-informed about the government who is largely responsible for making policy. Financially...we're not going to have total mayhem, banks collapsed. We're going to have a fat tax bill, bailouts of rich companies and industries, the stock market will bounce back and then exceed all previous records. I'd hate to be retiring in a year, but the economy on the whole is not going to collapse from this in any permanent way.

Nah. They kind of can't stop. They basically have PTSD. Imagine if in 2004 you went on a forum of soldiers online and asked if war in the middle east was real or just a media hoax? Maybe in 10 years when we've had therapy, naps, and time...we'll all be able to come up with something really diplomatic and kind to say when someone on the internet 2,000 miles away wants to know if the news is lying, in full, about over 20,000 Americans dying horrible, painful deaths while we watched at close range and tried to provide comfort while every square inch of our skin and faces were covered, or while we couldn't get there in time because of a 20 minute 'donning and doffing' procedure that some genius in an office came up with.

Oh, and someone mentioned 'do they have co-morbids?' Yes. We all do. It's called being an American. We lead a sedentary lifestyle, the VAST majority of us are overweight or obese, everyone drinks and smokes and does drugs like it's still 1995 even though most of them don't admit it, and we have ZERO healthy coping skills. We are also seeing healthy-appearing individuals requiring 3 weeks of mechanical ventilation, but mostly we're just seeing how unhealthy this great nation really is.

ICU nurse in a level 1 trauma center in the north east. We converted 45 of our ICU beds (2 ICUs) to COVID ICUs. They are full of intubated/proned patients with ratios as crappy as 4:1. I've seen more death in the last month than I have in nearly 10 years of nursing combined. Our morgue filled up last week so we had to call a refrigerated truck (luckily? NY did it first so our government had some ideas about how to handle the situation). It's difficult for the public to understand because visitors and unnecessary personnel are banned from the hospitals and COVID units. We're legally bound not to discuss it with any details about where specifically we work per social media policies and general nondisclosures and HIPAA stuff. The American public has too much time on their hands and POTUS is on TV for 2 hours a day contradicting public health officials at every turn. If you're not seeing this first hand, it's a lovely vacation for you. If you ARE seeing this first hand, you're wondering how you'll process all your PTSD in 6 sessions or less of therapy, because that's all that your employer-sponsored health care covers. It might take me 6 sessions to wrap my head around the fact that grocers and gas station attendants have received a 2-5 dollar an hour hazard pay bump (they deserve it, but so do we), and I got a snack size bag of potato chips and 17 emails about policy changes that I'll have time to read sometime next year. I cry on the way in to work every day now. I haven't cried about work since I was a new grad. I think the OP said he was in the midwest. Don't worry, you'll be seeing it soon. I saw the statistics about how many counties in rural areas either don't have a single ICU bed for the entire county, or have like, 6 ICU beds for several counties to share......you might be seeing it on your front lawn. Given how fast people go from looking somewhat normal to requiring urgent intubation (10 minutes sometimes)...we might not see the same case numbers because they don't have the same population or population density...but when the virus works its way there I don't even know that the shortage of vents will be the issue, people will die at home or on the way to the hospital. I mean, I honestly hope that doesn't happen, because I'm not a garbage human, but given what I'm seeing lately I'm not terribly optimistic.

Marie- they run the drips in our ORs but we have different ventilators, monitors, chart in different programs, they don't know where we keep things on the floor, depending on where they've been working as CRNAs some haven't used many pressors in the last 10 years, we've gotten new IABPs and cardiac output machines, and some just only have CCU experience and need a crash course on ARDS management if they've been doing elective procedures for years.

Doug we're legit manually proning them. Mind you last night was the first patient I proned who didn't weigh over 120kg. Proning does seem to be the most helpful thing we've done with the ICU COVIDs to actually improve oxygenation and survival in any meaningful way. I now hear that they're encouraging med/surg and non-intubated patients to basically prone themselves in bed which was weird to hear but is kind of cool and new to think about, for me anyway.

Yeah from whenever COVID started until about 4 days ago, management would basically give a verbal warning and then take disciplinary action against staff wearing masks outside of designated areas. I wish I had the ingenuity to start shouting report at my colleagues from 6 feet away during this time. I'm a big fan of having fun with policies. When we got 'dirty units' or COVID units- policy changed that we are supposed to wear a surgical mask at all times on the unit- in all locations, and put on our N95 and rest of PPE to enter rooms. About 4 days ago the rule changed to wear a mask 100 percent of the time while in any area in the hospital- they hand them out inside the front door. I haven't checked my emails about where we're supposed to be allowed to take them off and eat. Mostly because I haven't eaten food at work in a month.

Our CRNAs were basically told they could get laid off or have their hours seriously reduced, or they could come work as ICU RNs for the remainder of the shenanigans. They've mostly chosen not to work as ICU RNs, and I get it, but we're seriously short staffed, so I'd obviously rather they come work with me. You would think with all the urgent intubations throughout the hospital that we would need more anesthesia providers, but they're allowing ICU fellows/attendings to intubate their COVID+ or suspected COVID patients to minimize exposure to other staff in the hospital, especially during aerosolizing procedures.