The ICU nurse struggle

[ddr436]

Ever since becoming an ICU nurse I've been faced with a tremendous amount of anxiety when it comes to taking care of really sick, critically ill patients. Now let me explain. I'm not talking about the kind of critically ill patients that just need to stay on the vent over night or the patient that requires an arterial line to keep a close eye on their blood pressure. I'm talking about the really sick, unable to ventilate, let's do every test in the book kind of patient to figure out what's wrong with them. The kind of patient whose illness is so unexpected that all of family and friends gather at the bedside and ask the same questions over and over again. You see, the Dr. has updated their point of contact early this morning and has left to go on about their day and see other patients. I, however, am stuck in this room with my 1:1 patient trying to keep them alive, prevent complications and reassure extremely worried family members and friends. They try to rephrase their questions, hoping for a different answer. "Have you ever seen anyone this bad before", "What are the odds they will make it", "Do you think he/she will recover"...or my most favorite, incomprehensible by all non-medical personnel question Why is he/she so swollen?”. More people are showing up now and I watch as they walk in one by one, too afraid to touch their loved one but yet wanting to provide love and comfort at the same time. They are asking me more questions. I try to answer the best I can but I also try not to say too much because I know they will cling on and try to decipher every word. I have to hang albumin, I have to start another pressor and it's time to attempt oral care again. I explain once again what albumin is and why I have to start another vasopressor. I am diligent, I move with purpose and my eyes are constantly fixated on my patient or the monitor. I am in the room constantly. I hear every single piece of their conversation and although my patient is my number one priority, I can't help but feel for the family. I can't help but try to comfort them any way I could, even if it's offering water or snacks. I can't even begin to understand the amount of stress they are going through. This job, although worked for over 5 years, is not something that has desensitized me and it doesn't appear that it will ever be something that I am used to. I went to get my emissions testing done yesterday and everything was so routine, the words spoken, the motions, the paperwork. Nursing, particularly critical care nursing, cannot become this routine thing that we do.

As I am in the room taking care of my patient, surrounded by their family members, I am fully aware that they are watching my every move. I wonder if they blame me for their loved one not getting better. Do they think that I could be doing something better? Sometimes they question my skillset. One time I came on shift and I was orienting a new-to-ICU nurse and after we got report and I was done introducing myself, the wife of the patient asked me if I've done this before”. She was referring to the vent and drips….what I really wanted to say was No but I watched a YouTube tutorial so we should be good to go” but I know that my coping mechanism of humor and sarcasm would not be welcomed here so instead I simply said Yes” and went on to assess my new patient.

I often feel so much pressure. I have so many tasks and orders to complete. I have to draw blood, administer meds, empty drains, transfuse blood and assess my patient. How is it even possible to chart in real time? Oh and there's a family member on the phone, she's a nurse and would like an update on her cousin. GREAT.

[MYSTICOOKIEBEAR]

5 Years? Congratulations, that is more than most people last on the units . I completely understand where you are coming from, I know what you are going through, and know how stressful it can be. But for me, those are the nights that I live for and love the most about being in my CTICU.

I more often that not get the big big train wrecks , not like the coding and needing to do compressions/line/pressors/intubate train wrecks, but the open chest ECMO/Tandem or ECMO/Balloon pump, maxed on pressors, nitric, actively seizing, bleeding like a stuck pig really need to have my thinking cap on kind of train wrecks. But it is during these nights that I feel like I am really helping people and where I really shine . I very much agree with the patient being your number one priority and if you have time, appease the family. But there have been a few times where I have completely ignored family members or have not allowed them in the room for as long as 4-5 hours as I stabilized the patient to the point where I could actually breathe.

I no longer do the run around with patient family members, I am honest, informative, and to the point. If they continue to ask questions, I just keep on talking and give them so much information and detail that they just kind of stop (I absolutely love teaching so I love to talk about things that I am doing and things that are going on). Too many times have I seen the surgical teams not be completely honest with the patient's family members and only highlight the positives and completely ignore the negatives and then all of a sudden when the patient dies, the family is in complete shock. I think that practice is completely unethical and so within the scope of nursing and without giving medical diagnoses, I let the family members know the truth.

There have been a few times where family members have questioned my experience and skills without even seeing how I work and I get very annoyed but I never let it show. I tell them, in complete honesty, "Your family member has the best nurse here and will receive the best care possible". When they laugh, I keep a straight face, look them in the eye very intensely, and give a faint smirk. They usually get the idea after that.

I hope you realize that the work you do isn't something just anybody can do. It takes a truly special kind of person to keep doing this day in and day out. You have helped more people and have touched more lives than you will ever know . Keep fighting the good fight!

[RNEducator8056]

Dear overwhelmed,

First, you have to like what you do.

Second, you are dealing with human beings not just machines. I suggest, you take some professional ethics classes or read on the synergy model of critical care nurses by AACN.

Thirdly, take CCRN certification exam if you have not. Display your CCRN credentials in the unit proudly. That will send a message that you have attained the requied competency.

Good luck, I personally believe you're a very good nurse.

[CrunchRN, ADN, RN]

Just....thank you.

[Kooky Korky, BSN, RN]

Dear overwhelmed,

First, you have to like what you do.

Second, you are dealing with human beings not just machines. I suggest, you take some professional ethics classes or read on the synergy model of critical care nurses by AACN.

Thirdly, take CCRN certification exam if you have not. Display your CCRN credentials in the unit proudly. That will send a message that you have attained the requied competency.

Good luck, I personally believe you're a very good nurse.

You might have misread her statement that she can't/won't allow her job as a nurse of human beings in pretty rough shape to become mechanical, like emissions tests on cars.

OP - you need to set some limits. Are you allowed to set visiting hours? If so, please take advantage of them.

We never allowed families to be in our way in any setting, especially ICU. I worked it long, long ago, so it could be different now. But pt care and the nurses' ability to thing clearly always came before letting a lot of family members to distract us.

As for talking to the nurse cousin on the phone, forget it. You musn't leave the bedside to do that and there's HIPAA these days.

You have to become somewhat mechanized to survive, I think. Like our bodies, which do so much without our having to direct everything, a lot of nursing is routine, leaving you to focus on matters that require advanced thinking and doing.

Emoting is something with which we are blessed/cursed. Just part of the human condition. Do you journal? Have friends/coworkers with whom you can air your feelings? You could write a book, like some of the nurses in Vietnam did. Ever read " Nurse - Doctors Don't Keep You Alive - I Do". It's old and likely hard to find, but worth the hunt. You sound pretty normal to me, just stressed because you are allowing family members to overwhelm you.

Like the doctors, you must institute a communication tree. Each hour or two, give an update, if requested, to the point person, who can then disseminate it to other parties. Put a couple of points in writing if you prefer.

'

"Breathing better, lab results stable, urine output low so he is receiving IV fluids for that".

Assure them that you are with him every moment and there are 7 monitors and alarms to be your eyes and ears also. Or whatever.

I was never good at focusing on my patients while also being grilled by family and trying to be supportive of them. So I would honestly tell them that. And I would initiate the tree. On weekends, we had the same amount of work to do as M - F, but no secretary. And I told the families the truth and said that I really need to be at Bob's bedside so I won't be able to keep stopping to answer the phne. I told them to have their point person call every 4 hours or even every shift (8 hours). Never had any c/o about that - they wanted me with the pt, not on the phone with them.

[Lev, MSN, RN, NP]

As an ER nurse, I feel what you feel, not every day but definitely enough to recognize the feelings. Except I'm sure you feel it much more acutely than I do. I ship the patient hanging on death's door up to you and you have to deal with the terminal extubation. Fortunately I do not. I could never be a full time critical care nurse for the feelings you describe so well.

Sick patients are definitely anxiety provoking. I know the feelings of all eyes on me. They watch every move. Question every med. Crowd around the bed and I feel mean asking them to move so I can get to the monitor. Every BP that goes off they question. They come back to the room not prepared to see their family member intubated. I have to explain why we did what we did. Fortunately there is still some room for hope at the beginning. I do not give false hope. I do try to give realistic expectations. I don't say that their family member will probably die but I do say that their family member is very sick right now. I take it as a good sign of a family member's trust in me that they leave the bedside to go to the cafeteria for 1/2 an hour. It gives me strength that I know that they feel safe with me. When they ask questions like what are his chances I always say that he is very sick but every person responds differently to illness, no two people are alike and we are doing everything we can. In critical care, especially with sepsis, minutes do count and this can be the difference between life and death. If you can prevent an intubation through early recognition and treatment, you probably just saved your patient's life.

[Bluebolt]

I literally LOL'd when I read "why is he/she so swollen".

I hate it when family ask me that question. Well miss, it's because they are completely immobile in the bed with 7 IV drips infusing to keep them alive, tube feeding with the sedation is slowing down their gut, they've got liver failure with a very low albumin and now has acute kidney injury with a creat of 5.0 and has oliguria.

Even with our healthier patients most people in the ICU will stay in the bed most all day and will have at least a few IV infusions going, that's enough to make any of us a little swollen.

Sometimes I just want to say "humph, that's weird, I'm not sure" and just walk away. :)

[calivianya, BSN, RN]

OP - you need to set some limits. Are you allowed to set visiting hours? If so, please take advantage of them.

We never allowed families to be in our way in any setting, especially ICU. I worked it long, long ago, so it could be different now. But pt care and the nurses' ability to thing clearly always came before letting a lot of family members to distract us.

I wish that was still true. Visiting hours in my ICU are 24/7, but only one person is allowed to sleep in the room and there can only be two people in the room at a time. We had such huge problems with visitors being pests that we got rid of all the recliners in the rooms to encourage the visitors to stay out in the waiting room more, which helped a lot, but there is no kicking them out. We can only be subtly encouraging - "We're watching him very closely here!" "You need to rest while you can; he'll need help when he's more awake!" "I can come out to the waiting room to get you at any time!"

Actually kicking them out would make them unhappy, and of course, the unhappy and awake (read: capable of filing a complaint) person is clearly more important than the vented, sedated patient in the bed.