I Got My Dream ICU Nursing Job - Then COVID Hit
Written by Vanessa | BSN, RN, PCCN
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After four years as a nurse, I finally achieved my goal of becoming an ICU nurse!
I have never been so excited or honored. I moved from my Intermediate Unit and started training in ICU in January of 2020. In less than two months, COVID hit. I was getting used to my department, and I realized that everything I had just learned was about to change.
I remember hearing about Coronavirus from other countries. I remember the fear and angst that healthcare workers felt as we knew this disease was quickly spreading. Seeing New York City and all of the tragedy, I remember thinking back to nursing school. I couldn't have foreseen that I would be here, working the frontlines in a pandemic just a couple of years after graduating. It was too big and too real to comprehend.
We got our first COVID 19 patient in early March. COVID symptoms were so vast, and we had no experience with it. We treated everyone entering the ICU as a COVID rule out, which meant that for 24 hours, while we waited for their test to come back, we wore N95/ CAPRs, gown, gloves, goggles, and shoe covers, just in case, for every single patient.
We didn't have a treatment that we knew worked! We knew from our experience with ARDS (acute respiratory distress syndrome) how to help the symptoms, like proning to assist with oxygenation. But we did not know how the disease would progress; we were learning what would work and what wouldn't work as we went, and there was no sure solution to apply to each patient.
The Psychosocial Impact of COVID-19
I have never cried so much or gotten so attached to patients as I have this year. COVID is terrible; we all know that… but it is also the psychosocial aspect that has been heartbreaking.
As a nurse, the feeling of isolation in a room is haunting. I know many nurses must have felt this. When the patient is on airborne precautions, you cannot leave the room to freely grab something or open the door to talk to someone.
Entering and exiting the room takes at least 3 minutes. With all the donning and doffing of proper PPE, the last thing you want is to forget something. Before COVID 19, when a nurse got a new patient, all the nurses that were available on the pod would jump right in; we were so lucky to have such awesome teamwork! Unfortunately, since the room was on isolation precautions, this could not happen. We only had limited staff in the room, usually one to two nurses, a respiratory therapist, and a provider.
Patients deteriorate quicker with COVID than any disease I have experienced. I cannot count the number of times a patient has looked me in the eyes and expressed their fear of death.
Their Family Can’t Be There
I hold the hands of struggling patients, trying my best to comfort them in the scariest moments of their life. Patients who would usually have the ability to have their families with them before the COVID restrictions, now only have their healthcare staff to turn to for support.
Our staff has made it a priority to join the patient in calling their loved ones before intubation. While not everyone who is intubated loses their fight, each patient experiences all of the devastating moments of a last goodbye. Hearing a family's goodbye, that fear and dismay in their voice, it's tragic. Before COVID, we may do this a handful of times; now, I may do that every time I work a shift.
COVID affects everyone differently. While I have been caring for these patients for over a year and feel confident in my skill, I still struggle to cope. Why do some people get so sick? Why can't we figure out how to make them better?
With the instability of COVID patients, nurses are in the room with the patient alone for hours.
Maybe They Hear Me
When it's only my patient and me, there's a wonderful opportunity to talk to my patient. It's not a conversation - in the ICU, our COVID patients are rarely awake - but I like to talk to my patient as though they were awake and can hear me. They are sedated and sometimes chemically paralyzed to help them tolerate the ventilator, but they are human. We are titrating medications, and with so many machines in the room, it is important to remember who they are. I think about how I would feel in this situation.
I tell them what the weather is like, what the date is, what their family said on the phone. I tell them it is clear they are loved and that their family very much wants to be with them.
I like to tell them what I am doing and what the plan is. Who doesn't like to know the plan, right?
I'll hold their hand as I point out something that seems to be improving. If there is any way they can hear me, they need to know I am there with them, and we are in this together, as a team.
What Sticks in My Memory
I have heard many times that there will be patients that stick in your memory. There is a special patient I will always remember, a little itty bitty lady, maybe 4’11. She was transferred from the emergency room for low oxygen saturations, needing intubation. She was a current cancer patient who was already immunosuppressed and was exposed accidentally by a family member.
This sweet little lady struggled to breathe, but her biggest concern was not herself but her husband, who had also been admitted. I remember sitting down next to her with another nurse and just listening to her. We each held her hand while she was proning in bed, trying to raise her oxygen saturation. As she struggled for breath so told us how alone she felt.
Sometimes as a nurse, listening and being present with your patient makes all the difference. We knew intubation was imminent, so we arranged for her to face time with her daughter, son, and husband. A few weeks later, she passed. All of our knowledge, all of our trying, was not enough to save her. I can still hear her voice.
I Still Love This
I love nursing. It is a fantastic profession, and I am thankful I chose this path. I make a difference by comforting someone in their worst moments. This has been a year of pain and growth. The thing that has grown the most is my gratitude. Gratitude for my family. Gratitude for my amazing fellow nurses. Gratitude for the ways that the people surrounding me have supported me as I help my patients.
People don’t know how to talk about COVID with nurses. And, it's true, not all of us know how to react to the “thank yous”. But we need it. It makes our days more tolerable. Expressing gratitude is something that more humans should practice. Nurses can't do it alone. Thank you to all who have supported and been on our team, we are forever grateful.
If my story resonates with you as a nurse, follow the EARN blog for more from local nurses. EARN has 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 Vanessa RN BSN PCCN; I am so excited to be a part of building a better way for RNs and NPs to be precisely matched with nursing positions that really fit them. I’m fueled by almond milk lattes ☕️, especially after a good workout at F45💪🏼, and of course wine 🍷