Want to swap to ICU but I cry during codes

[Aliareza]

I'm currently working on an ortho floor at just over 1 year into nursing and am ready for a change. I love my ortho patients but we're just too short-staffed for me to properly care for them, and my manager is never going to grow a backbone and fight to change that. I'm burned out.

I'd like to go to ICU, but as you can imagine, I feel pretty underprepared. I've bought The ICU Book and I'm going to study up on all the things I know that I'll need to know in ICU that I don't use now, and I have every confidence that I'll do great with the learning. The only thing I dread is becoming overly emotional.

I've had several patients die on me, but never while I was there. I was sad for them, but never felt like crying or anything. Then one night, a patient coded. It wasn't my patient, but the code was pretty awful as far as codes go. It was super unexpected, it lasted nearly an hour, and the patient's children were nurses in the hospital so they were called from their departments. They stood outside the room to let the code team work, sobbing and screaming at the patient to please come back, don't leave them, the entire hour. The patient did not make it.

I feel myself tearing up every time I even think about it. Whenever I hear a code called now, I immediately feel like crying. I'm the type of person who can't see other people crying without feeling like I want to cry myself. I don't know if I'm strong enough emotionally to work in ICU and keep the distance I'd need to keep in order to be a strong supporter of families in their time of need instead of just another person crying. I don't know how I could possibly do chest compressions on all these little old ladies who are full codes that we get on ortho all the time. I'd feel so horrible doing it. It's not right, but that would be my job.

In short, I just don't know if ICU is right for me. I feel like I care too much and have too much empathy for it. I'm scared of it sticking with me, of taking it home with me. I already know I could never work with babies or children because of this. Any guidance would be appreciated, because my brain is like "Yes, ICU = growth and knowledge!" but my emotions tell me to stay away.

[Ruby Vee, BSN]

I'm sure you're going to get a plethora of responses about whether or not you should transfer to ICU given your emotional challenges. I think the bigger question is have you been at your current job long enough to become expert AND long enough to give the manager who hired you some return on her investment? And the answer to both is no. It takes approximately two years to become expert as a nurse or in a nursing job, and it takes that long to give your manager a return on her investment. My advice is to stay where you are and put in your two years.

[Lev, MSN, RN, NP]

usually patient's code in the ICU. if you want a change you could try ER. there are actually less codes in the ER it seems than the ICU, of course variable in regards to hospital location and size.

Keep in mind that ED gets many patients who come in coding and don't make it so you have to count those in the numbers of "patients who code" in addition to those who make it and go up to the unit post arrest.

[Lev, MSN, RN, NP]

The code you witnessed was unusual because you were able to have empathy for the family members who were staff nurses at your hospital. To see a fellow coworker going through a painful experience, you may automatically put yourself in their position. They also reacted with a lot of emotion - yelling and screaming, etc. Not all codes are like that. Many patients who code are critically ill anyway and in ICU may already be intubated. The family is already grieving their family members (hopefully) from the time they enter the ICU. Codes on Med-surg floors are more unexpected because "they (the patient) were fine." i don't think crying during one emotionally charged code should keep you away from ICU. However, make sure you are competent in your current setting before moving into critical care.

[calivianya, BSN, RN]

Codes are less stressful in ICU in general because people know what they're doing. No offense to nurses on other floors, but I had my first two codes in inpatient rehab while I worked there as a CNA and the nurses were all panicky and freaked out, some crying, and honestly it took a few minutes to even do something simple like get the pads on the patient. The first code, the patient was in a wheelchair when he arrested, and whether to get him to the floor or get him to the bed was a point of argument, and people were confused what to do, and were even wondering whether to get the hoyer lift or put a sheet under him to get him out of the wheelchair... it was a nightmare.

Codes in ICU are 100x calmer. There isn't that panic feel, and usually, the patient has been very sick for a while and it's not totally unexpected. It's not usually unexpected at all for the ICU nurse - who has likely been watching the heart rate drop, BP drop, SpO2 drop, an increase in PVCs, a widening of the QRS, or something similar for at least a few minutes. I have yet to have an out of the blue arrest that I didn't already have the crash cart in the room for.

I've had a few sobbing families, but most are sad but calm because we'd been talking to them about the patient's heart stopping for several days and have been trying to persuade them into making the patient a DNR anyway. Many ICU codes stop as soon as the family gets there, because they finally understand what we've been talking about once they see us doing compressions and they don't want unnecessary pain and suffering for their family member.

So, don't judge how you'd react during an ICU code by how you'd react during a code on a regular floor. It's not the same thing.

[Corey Narry, MSN, RN, NP]

Agree with last two PP's. Not all codes are the same. I'm sometimes part of a hospital-wide code team for our adult patients as an ICU NP. And after over 20 years of being a nurse, I will not deny that some codes still get an emotional reaction out of me...like a code in OB for instance.

OP, I would reflect on why this particular code affected you and still does. I hope you get to experience other codes where your involvement as part of the team is more active and see if it impaired the way you carried out your role. To me, it's fine to be emotional (or even get tearful) but as long as your mind remains sharp and you can carry out your duties to save a life.

Also, your facility has a duty to make sure staff involved in an emotionally charged code are taken care of - a debriefing is usually in order in those instances.

[armyicurn]

If you can't handle codes, don't do it. Codes don't bother me but the pts that are rotting from inside out, or outside in. Laying in the bed crying, on the vent, pressure to soft to medicate are the problem. Families that want everything done while mom sits in the ICU alone with the most horrific skin, wounds etc. That's the part about ICU that can get to you. One thing I have learned in the years of being a ICU nurse is... There are worse things then death!!

Well said! OP, if you have the burning desire for critical care, start in the ED. As already said, less codes. If you go for it, you need to expose yourself to them. It is not easy and EVERYBODY goes through a stressful time. Practice, practice and practice what you would do in a code. Did not read the entire thread, but not sure if you mentioned you have ACLS. How do you do with mock codes? What part of the code stresses you the most? giving meds? compressions?

If you are the type that gets easily attached to your pt's, then be very careful what you ask for. I've only experienced being emotionally attached once or twice... The one that is very vivid to me is when I took care of a WWII, Korea and VietNam conflict veteran. He worked my rear off and I was on my feet for my entire 12+ hours except for the 3 min bathroom breaks. I worked very hard to keep him alive until his last family member flew in later that night. He passed shortly after all the family was there. It was such an honor to have cared for him.

Good luck!

[Salter444]

There is no crying in baseball or during codes. The focus belongs on the teamwork and the patient...if you cannot control your emotions then you have no business being in the code. Does not make you a bad nurse just not right for areas where codes are a fact of life.

[MYSTICOOKIEBEAR]

I will admit, the first time that I had a patient that was close to me die while still new-ish to The Units, it hit me VERY hard. So much that I had an existential crisis and went on a $3000 shopping spree the next day because I was so upset and realized how quickly one's life can end. It took me a while longer to get used to death and to realize that it is a part of being a Critical Care nurse and the setting that we work in. I realized that sometimes we can do everything right and the patient still dies, sometimes it is just time to go and there is nothing that any of us can do about it.

As long as we did everything right, whether the patient lives or dies, I can hold my head up high and proud and not feel too bad. I will admit though that it can be difficult when the patient in question is a very good and loving person just based off of the family and friends at the bedside. It makes it a little tougher, but that is life.

I actually made a video about roles and positions during a code that might help you in your future endeavors. Good luck on The Unit!

[ElizabethAnsley]

I'm a new grad in an ICU, and honestly, codes are NOT the saddest things you see. There are so many more aspects to critical care than codes.

Every patient you'll get is VERY sick, well, I mean... they are in the ICU after all. This makes patients and families alike VERY stressed out. A lot of times you'll have unresponsive patients and all day you will listen to their families cry over their loved one, begging them to pull through and make it. You'll see grown adults breaking down because their father/mother is so sick that they can't open their eyes. Being compassionate is very important, but it is also important to care for your patients and their loved ones without allowing yourself to get too emotionally involved.

You'll have a patient you've taken care of for months. You know everything about them, everything about their spouse, their children, their pets, their homes. You'll get hugs from their family when they see you, and they'll bring you leftovers from their last dinner. You'll grow close to them... and then one day they decide to withdraw care and you're the nurse. You're the nurse pushing morphine as your patient struggles to breathe without the ventilator, but you immediately have to handle that death so that you can leave the room and take care of your other patient. Or maybe you're not the nurse. Maybe they withdraw on your off day and you come into work with full expectations to see this family you've grown accustomed to... and they're gone.

You'll code a patient multiple times every day because the family wants to keep that person alive so that they can receive a benefits check. And you know what? You can't stop just because you're angry/sad because you think you're torturing their mother/father/brother/cousin/neighbor. You continue on because it's your patient and you have to respect code status, regardless of family situations.

With that being said, I can vividly remember my first code in the ICU. My patient was admitting walking and talking and a few hours later brady'd down, I couldn't doppler a pulse, and I started compressions. I remember hearing his ribs crack, I remember yelling for the doctor and my charge nurse. I remember getting his under 10 year old son in the room after coding him for so long and telling this child to tell his father how much he loved him and to tell his dad about how his day at school went went. I remember begging him to tell his dad about his day because I never wanted him to regret not telling his father goodbye when he got older. And I did so compassionately, solemnly, and immediately had to go next door to extubate my other patient and celebrate with that family that this person is stable and ready to be moved to the floor the following day. And that, my friend, is a day in the ICU.

It's very tough as a new grad. It's tough as a seasoned nurse. If you want to do it, I have full faith in you. It takes a lot of time personally and academically to prepare.

[TicTok411]

and it takes that long to give your manager a return on her investment. My advice is to stay where you are and put in your two years.

I can maybe agree with some of your argument but this line is so off! Her investment??? Does this manager now own the hospital and write checks from HER personal account? I would not want to work at that facility. Reality is that the manager is an employee just like the nurse and has no skin in the game. You do not make career decisions based on a fellow employee.

[Ruby Vee, BSN]

I can maybe agree with some of your argument but this line is so off! Her investment??? Does this manager now own the hospital and write checks from HER personal account? I would not want to work at that facility. Reality is that the manager is an employee just like the nurse and has no skin in the game. You do not make career decisions based on a fellow employee.

The manager is an employee with hiring authority who used some of her hiring budget to take a risk on hiring a new orientee. If the OP wants her resume to reflect professionalism and wants a good reference from that manager, she would be advised to stay on the job long enough to make the money invested in her orientation an investment rather than a loss.

[Greenclip]

So out of the frying pan into the fire?

Don't know about where you work, but the smaller ER where I am has 10-12 codes per week (sometimes more).

There is a Code Blue somewhere in the 200 bed hospital (including the ICU, but not the ER) maybe daily, so a lot less codes in our ICU.

I agree. I'm at a large Level 1 trauma center. We have codes way more often in the ED than in the ICU. I've been working in ICU three years...I personally haven't had a patient code yet, although I did have one who coded about half an hour after handoff! (I knew she was going to go down and already had the crash cart there.) As others have said, in the ICU you can usually tell when a code is imminent.