Written by Jeanine Maine - DNP, RN, CCRN-CMC, CNE

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Working in the ICU during COVID is like working in a war zone. Every shift, we go into battle with our N95 respirators, face shields, and a prayer. We are fighting an enemy that we don't know how to beat. In this war, we are facing incredible adversity; we don't have enough supplies or troops. In the beginning, I was scared every day. I was frightened of contracting COVID or, worse giving it to someone I love. It was very quickly that my fear was pushed aside and replaced with other emotions: despair, guilt, anger, and exhaustion. I have dealt with all of these over the 12 years In ICU nursing, but this was every single shift. Non-stop. Never-ending. The best way to understand how ICU nurses are experiencing these feelings is to share my experiences that have left permanent marks on my soul.

CARL

My patient, let's call him Carl, was in his late 50's. Carl entered our ICU treatment for COVID pneumonia. After several weeks of battling pneumonia and developing kidney failure, Carl was placed on comfort care. When I arrived on shift, Carl was in the early stages of death. I made sure he knew I was close by and medicated him for pain and anxiety. Throughout the morning, I made it my priority to check on Carl frequently as he was alone. At the beginning of the pandemic, we did not allow any visitors for any reason, even end-of-life. If you ask any nurse, they will tell you that they would never let any human being die alone.

Around 11 am, I noted that Carl's heart rate was dropping fast on the nurse's station's central monitor. 120, down to 80. I knew I had to act quickly to get to him in time. I started to scramble to put my PPE on. I look up at the monitor, 50 now. I start to move faster. All I can think of is you have to get to him. N95 mask, the gown is on… Heart rate is 20 now. I am rushing to put on my gloves and face shield… I don't make it time. He is gone.

I felt the air leave my body. I failed. I went to him and apologized. I'm sorry I did not make it in time. I'm sorry you were alone. I hope you weren't scared. I hope you weren't in pain. Carl died April 2020. I still feel tremendous guilt about not being there in his last moments on earth. I will carry Carl with me for the rest of my life.

By the Holidays

• I am exhausted and angry.

• I have been caring for COVID patients since March.

• We are at 150% capacity in the ICUs.

We are being forced to care for ICU patients on regular floors and observation units that are not set-up or ready for these patients' critical needs. I have witnessed patients that needed life-saving treatments, but we did not have the equipment or staff. While the hospital units are on fire, I see people posting on social media about their upcoming holiday plans, posts inviting 30 friends into their home for a Christmas party. Meanwhile, I am watching people die, knowing that we can't save them if they get sick.

EMMA

During Christmas, Emma contracted COVID from a family member at a Christmas gathering. Emma was a healthy and active woman in her 50's. Her family who knew they were positive with COVID and came to the family gathering anyway. During my shift with Emma, we attempted to wean her off of the ventilator. Unfortunately, Emma's body wasn't ready. The doctors decided it was time to discuss the need for a tracheostomy and long-term ventilator care with Emma. Emma received the news and was feeling quite low. I spent an hour talking with Emma and holding her hand. I could see Emma going through so many emotions: anger, sadness, regret, and hopelessness. I arranged to have her do a video call with her family in the hopes it would raise her spirit. Because Emma was on a ventilator, she cannot speak to her family, so I assisted her with communication using a communication board. As soon as her husband, children, and grandchildren popped up on the tablet screen, Emma started aggressively pointing her finger at each family member. I asked her to use the communication board, and she spelled out "masks." She wanted her family members from different households to wear a mask. I communicated her desire with her family, and they refused. Emma asked again and began to cry. Her family could see her crying and struggling to breathe on the ventilator and still refused. Finally, Emma communicated either they put on a mask, or she would end the call. How could a family see their loved one in that state and refuse to wear a mask? Thank goodness for PPE because I was livid, and I'm sure my face showed it.

Hanging By a Thread - Fighting for Hope

Healthcare workers are hanging on by a thread right now. We have seen and experienced trauma that will leave a permanent mark on the nursing profession. I recently volunteered at a vaccine clinic, and I cried. I cried on and off the entire day. I am desperately looking for any indication that this may end and my soul can heal. I hope that these horrible feelings from the last 11 months will be replaced with hope, wellness, and peace. And in those hopes, I extend my solidarity to all my fellow nurses and health care workers. Thank you for being in this fight for hope with me.

If reading my story felt cathartic, keep up with the EARN blog for more. They have a vision to precisely match RNs and NPs with the positions and organizations that fit your skills and personality. The right fit means everything.

👩🏼‍⚕️ Hi, I'm Jeanine; an experienced DNP, RN, CCRN-CMC in AZ, I'm fueled by AZ Wildcat Basketball (Bear Down), caffeine ☕️ family, and friends.