And we are getting over run. It's bad out there. Everyone is short staffed.
I've been thinking about the term ICU and what it means to me and how I'm growing to understand it. This is just me musing. I realize more and more that we don't "save" people like someone coming in with a cape like the Emergency Department. ICU is a journey. I read a book once that said that the job of the ICU nurse is to keep their patients comfortable and try to prevent suffering while they medically manage the body's reaction to a disease process (paraphrased). That stopped me dead in my tracks. We give them a chance and their body fights disease or it doesn't and our job is to keep them as comfortable as possible through this journey. The problem is there are not a lot of ICU nurses compared to floor nurses. My old hospital had only 12 ICU beds. But we could have 140 plus regular beds on the floors in the same hospital. If someone got too sick and needed ICU but they were full, then start looking to see who the most stable patient is and ready them for the floor. If that is not attentable or safe, then someone needs a transfer to another hospital in the network, likely the Pt who is crashing once stabilized. But if 40 people need ICU level of care all at once, you're up a river no paddle and that is what is starting to happen now. The problem is, if staff is too overloaded, things can get missed and mistakes are risked with very intense patients. These COVID patients are more technically heavy than other run of the mill ICU patients. They have clots, sepsis, ARDS, DKA, heart failure. Often times, a patient will come to the unit with only one of these as the reason for admission but COVID patients get all of them which make them technically heavier cases. ICU nurses are notorious for saying, I can give great care to 1 patient. 2 is too much. Other nurses who manage 4 or 7 patients laugh at us for that. Hospitals double the more stable patients with an RN. 11-13 nurses for 16 patients results in 2 to 3 doubles. But here is the catchy, when you look at the complexity of this virus, it leaves little doubt to why I lose my shit at people when they talk about the kill rate being nothing. Our job is to know the patient better than they know themselves by how they breathe on sedation, breathe on a vent. Little things like how they quick they were to respond to our voices when we talk to them and then suddenly the seem a little more confused (infection? clot? stroke? maybe just a little oxygen? maybe the pain meds?, not enough or need more? labs? Ammonia? Pneumonia? or is it delirium or lack of sleep?). And to anticipate the next step. A lot these COVID patients cannot be doubled. They are just too damn heavy.
COVID, patients can stick with us for weeks or months in ICU on their journey which means some tough decisions are going to have be made on who gets care and who doesn't if we get totally over run and into crisis management. There are only so many beds, only so many ICU nurses. I'm hoping the gov pulled the chord soon enough.
We can give meds and hang drips, but we can't force the body to respond. A lot of it is will. A lot more than one would think. Having family at bedside plays a huge role because it reminds people why they keep fighting but that goes away with COVID because families are not allowed at bedside. So they waste away, slowly and very alert to what is happening unless they are heavily sedated. This journey can be prevented through mask use. It doesn't matter anymore how we feel about masks because we're at the tipping point where the gov is stepping in and now locking it down because they recognize we can only hold on for so much longer. I know it can always get worse. I've seen worse. I go to sleep seeing worse somedays and see it again when I wake up. I hear blood pressure alarms for hours after a shift. It's weird to decide between a hot chocolate and a muffin 20 minutes after doing compressions on someone's chest. I feel guilty about it. But I have to remind myself that was their journey. Not mine. And these events are becoming too frequent, they are less stable, crash fast. And we're very much human and are the last line of defense in this mess.
