Today I woke up feeling like I had a hangover. I’m starting my 4 day break from the ICU, after working 6 of the last 8 days. I drug myself down the stairs and starting cleaning house as I normally do on my days off. I glanced at myself in the mirror at the bottom of my stair case. Horror. My face blatantly shows the pure exhaustion that I feel, and my hair looks a complete mess. “Thank god I’m off work today and my patients won’t have to see this worn out version of myself” is my first thought.
People who aren’t nurses always tell me, “You only work three days a week? Wow! That must be great. I wish I had your schedule!” ..Only three days a week? ONLY!? I wake up at 4:30AM, shake off my fatigue, drive an hour to work, and then begin my scheduled 12 hour shift. 12 often turns into 13 hours or even more depending on the patient load and if I were able to keep up with my charting. When I’m done and finally clock out, I drive home arriving around 8PM, where I strip out of my scrubs and collapse onto the couch where I snuggle my cats and tell my husband about my day until I pass out from exhaustion. I slip upstairs to bed, to the disbelief of my husband that I could possibly be so tired, and I set my alarm and prepare for my next shift.
ONLY 36 hours a week. But does anyone who’s not a nurse know what those 36 hours consist of? Juggling all my nursing tasks for each individual patient while also trying to communicate with the doctors, pharmacists, respiratory therapists, PT, OT, social work, our aides, the patients themselves, and their families?! Yes, that’s right, I communicate with all of these people on a daily basis. I am personal coordinator for my patients. I am their voice, their advocate. I must be aware of my patients needs at all times. Room 101 is going up stairs to cath lab at 0900. 102 wants their pain medicine at 0915. 103 needs to be turned at 0930. Got it. My mental check list is a never ending dynamic that I must prioritize and rearrange constantly.
My job is scary. Always thinking, always analyzing, ALWAYS aware of my actions. I could cause a patient to lose their life if I am not critically thinking about everything that I do and every medication that I give. Is this dosage appropriate, does this patient need this medication? It is all my responsibility to keep the patient safe.
Even when I am doing everything that I can it isn’t always enough. I’ve had family members displeased that I took a little longer to answer a call light. I’m sorry that I couldn’t get you a coke right away, I was busy titrating a lifesaving medication in the room right next to yours. I have been asked by a family member if I were qualified to even be a nurse, surely I was too young for that. I have been told that I am too weak to help lift a patient when in reality I can lift more weight that I weigh. Nursing is hard. I take all these comments and offer a kind response to remain professional even though it can make me feel really small at times. Not feeling appreciated is hard when all I am trying to do is help.
I have been there when a patient said their lasts words before being intubated and never being able to come off of the vent. I have been there as a patient has taken their last breaths on the earth. I have been there when a patient has decided that their body can no longer fight, and they would like to receive comfort care. I have provided comfort care as family members are silent, with tears streaming down their faces, as I turn the lifeless body of their once resilient family member. I have been there when a doctor has told a healthy, active patient in front of their spouse that they have stage 4 cancer, and will not survive. I have stood and held my tears to remain strong for family members who have had their hearts shattered by the news that their loved ones will not be coming home again. I have sobbed on my way home from work because my heart is shattered too. I am so sorry that you have to go through these things. I am so sorry that your loved one has cancer. I am so sorry that myself and the doctors couldn’t get your loved one to wake back up after being sedated on the ventilator. Nursing is hard. I am human. I care about my patients. How could I not? My heart breaks along with my patients and their family members. Then I go home and try to pretend that I have not been broken during my shift. I don’t want to burden my husband with my sadness, and I need to pull it together so I can go back to work in the morning and do it again.
So how do I do it? How do all nurses do it? How do we manage ONLY 36 hours a week? Because nursing is beautiful. I have been there as a scared patient on a ventilator has woken up so I held her hand and told her that everything would be okay. She could not speak as she had a lifesaving breathing tube down her throat. Somehow she managed to grasp a pen with her weak hands and wrote “I love you guys.” My heart exploded with joy. I have provided comfort to someone when they were far from comfortable. I have been there when a patient has come off of a ventilator after being on it for a week, and watched as they cried and said they were so happy to be alive. I helped bring that person relief. I have bought lip gloss for an elderly patient whose son forgot to bring in her lipstick. The smile on her done up face was priceless as she put on the lip gloss to complete her look. I have made a patient genuinely happy even though she is sick and in the critical care unit. I have been there providing comfort care to a dying loved one and family members have hugged me and thanked me for being the angel that their family member needs. Nursing is beautiful. Life is beautiful. I watch lives change, I watched lives end, and I watch lives get a second chance because of the care and medicine that I have provided.
Nursing is hard. Nursing is stressful. Nursing is exhausting. It drains me both physically and mentally. I come home tired, sweaty, and defeated. Not all days are good days. Nursing is not all sunshine and rainbows. But nursing is my life. I dedicate my life to saving the lives of others. Those break through moments when a patient miraculously recovers, when a patient holds your hand and tells you how thankful that they are for you, and the moments when myself and a patient can share in a good laugh. The feeling of pride I feel when my patient came in on a ventilator but walks out at discharge, makes it all worth it. All the wonderful, precious moments are why I love nursing. The great moments are what get myself and my coworkers through the long, difficult 12 hour shifts. Thank god for fantastic coworkers. My coworkers are like my family. I know that they understand the mental turmoil that I go through after a hard day. Only nurses understand truly what nurses go through.
So the next time that you want to tell a nurse that it must be great to work ONLY 36 hours a week, please be mindful of what those 36 hours are like. Give a nurse a hug today, and be thankful that we continue to do what we do, and don’t judge us when we drink a little extra wine. If it were easy, everyone would do it.
but still smiling ICU nurse.
But their existence will float away And just like every word they say And we will hold hands as they fade
- Avett Brothers
The day I let you down, should have been like every other day. Should have been straight forward and we should have done what you needed. We should have done what you wanted. Instead I let you down.
We had known each other for a while. You were the sweet lady that huffed and puffed to breathe after a lung transplant that left you with really only one viable lung. You had a sweet smile and you knew me on sight. I would come by your room when you weren’t my patient and say hi and chat for a moment. You were a tiny lady with a big beautiful heart.
Two days ago I was assigned to you. You called me by name and we spent the day arguing about whether you would get to drink or not. You couldn’t so I put a feeding tube in and tears formed in your eyes as I did. I apologized profusely and you smiled weakly at me. Half way through my shift you called me into your room and gripped my hand.
“I’m not.. gonna… make it.” You said between breaths. You stared at my face as you said the words. I looked at you in surprise and quickly reassured you a best I could. Your numbers all looked good. Stable. You looked at me resigned and nodded as I told you that you were improving. You asked to go on the bipap so you could rest and I tucked you in.
The next shift- you told me you wanted to be done. You told me to turn everything off and take all your tubes out. There was no mistaking what you were asking. I talked to you at length about it. I asked if you knew what taking all of that away meant- you nodded and asked me to help you. I squeezed your hand and told her I would talk to the doctors and your family. Hours later- your daughter, despite hearing your pleas that you are tired and wanted to rest and be done, told the doctors to do everything. Despite the fact that your head shook a violent “NO” when asked if you wanted intubated if need be- your daughter said yes. Despite my telling the doctor that you had appeared to be in your right mind for me, they labeled you confused. I hung my head when they told me what they decided. I avoided the room for a few hours because what could I possibly tell this sweet soul that I had promised to help?
I snuck in as you rested, your breathing labored and the bipap obstructing most of your face. I turned around and your eyes opened. You waved me over to you and I hesitantly walked to your side. You mumbled something through the bipap and I leaned closer to hear you. You tried again and I apologized for not understanding. You shook your head in frustration and I popped the bipap off so you could tell me. “When are you going to release me from all this? When are you going to let me go?” You said in between your labored breaths, your hand gripping mine. “When are you taking the tubes away?” I stared at you and squeezed your hand. I didn’t know what to say to you other than the truth. “I can’t…” I said my voice on the verge of breaking. “Your daughter… your family…They want you to keep fighting. They want everything done. The tubes have to stay.”
The look on your face when I spoke those words to you made my heart physically hurt. I didn’t know how else to tell you that you had been betrayed. By your family… By your doctors…By me.
You shut your eyes and laid back on the pillow. The family members that had been left to “encourage” you, stood awkwardly to the side. I straightened your lines, pulled your blankets up and was about to go when you raised your hand. You set it gently on my arm and looked at me. “Thank you.” You said loud enough that the bipap didn’t smother it. I squeezed your hand and we shared a moment. I didn’t look at your family. I looked at you, my eyes glistening with the same frustrated tears that mirrored in yours. I nodded and you closed your eyes. The day I let you down, should have been like every other day. Should have been straight forward and we should have done what you needed. We should have done what you wanted. Instead I let you down.
I recently had a patient who was seeing things. He was convinced he was at home and that there were bugs everywhere, and kept yelling for his wife and trying to climb out of bed.
He knew that I didn’t believe he was at home and so finally he said “okay, I have a bunch of people here who can verify for you in person that the things I’m seeing are real”. He then introduced me to his wife and 2 children, plus a nurse from a hospital in a different city. Afterwards he said, “so do you feel better now that other people have told you I’m not seeing things”.
And I had to tell him no, because I was the only person in the room with him lol.
Hiya, Aunty! Has anyone ever asked yet what the differences between each ICU type is because I still get confused by them
Hey nonny! No, this is the first time this question is coming up, which means that I get to go off about one of my favorite topics!
An ICU (Intensive Care Unit) is a special unit in a hospital for a patient who is “critically ill”. There are a lot of reasons people can be admitted to an ICU. (In the UK I believe these units are called ITUs, Intensive Therapy Units.)
ICUs are areas where extremely sick patients get closely observed. Where an ER or medical-floor nurse might have 6 or more patients to attend, an ICU nurse has just one or maybe 2. They’ll get more frequent visits from doctors, have their intakes and outputs (”Is and Os”) monitored, medications adjusted, very frequently. If they’re on a ventilator or respiratory support, they’ll be in the ICU. Serious chemical and salt imbalances or extremes of blood sugar, blood pressure, and organ function are seen in the ICUs.
There are loads of different types. Some small hospitals may have only one “catchall” ICU, for the “really-sick” patients. Some may have dozens; I work for a hospital system with a great many ICUs. Generally, patients are sorted based on what service they primarily need.
The Medical ICU (MICU) is where generically medically-sick patients go. Issues like sepsis are handled here, as might asthma patients, patients with acute abdomen, etc.
Though this gets tricky: some hospitals also have a Respiratory Care Unit (RCU).
Many post-operative surgical patients are discharged to a Surgical ICU (SICU) from the OR. SICU can also hold patients pre-op for observation and testing.
One type of SICU is a Cardiothoracic ICU (CTICU). This is for patients who have had their chests opened during surgery for whatever reason, as the possibility of re-bleeds requiring immediate surgery is high and the consequences can be rapidly fatal.
Critically ill heart patients – including those who’ve recovered from cardiac arrest or suffered heart attacks with significant damage – are admitted to a Cardiac Care Unit (CCU).
Neuro ICU (NICU) and Neonatal ICU (NICU) (which is separate from a Pediatric ICU (PICU)) share the same abbreviation but drastically different populations; Neuro ICUs treat patients suffering from strokes or hemorrhages in the brain, while Neonatal ICUs treat critically ill newborns. Some hospitals will call their Neuro ICU a Neuroscience ICU (NSICU) for clarity, but this is different when a hospital has a neuro ICU and a Neurosurgical ICU (NSICU).
There are also Burn ICUs, Trauma ICUs, Post-Anesthesia Care Units (PACUs) and more. (PACUs may or may not count as ICUs, actually). Then there are “step-down” units, where people are “de-medicalized”, weaned from their biggest interventions before being sent to a more routine kind of a floor.
Ultimately what each hospital chooses to call each ICU is up to them. One hospital I know calls their Trauma ICU their “Emergency Ward”. Our “mothership” hospital calls their neuro ICU their Neuroscience ICU.
Oh, and children’s hospitals may have…. honestly, at least a few of these ICUs, dedicated just for kids.
I hope that helps clear things up a little bit. Let me know if you still have questions, I’ll try to help answer them as best I can!
Tell us again how hard your job is. Tell us how since we only work ‘3 days’ a week we have it easy. Tell us to leave work at work. Tell us to smile and not think about who is in the bed, in our care when we are off work. Tell us that we are just nurses…