I'm an ICU nurse AMA.

[AluckyEllie]

Just that really. In the current climate people are getting a view into our day to day job, and what it involves. It's a rainy Saturday and well...AMA!

Thank you for all the work you and your team do.
Obviously people in ICU are the sickest of the sick be it from illness, surgery or accident....and many won't make it despite your help.
With your knowledge and experience are there any 'rules' you would want to follow for yourself or your family regarding going into ICU or how long you continue to help considering its effect on the body..

I realise it varies from person to person and there will always be some that beat the odds..... But do you have any general rules!

Also what do you think surprises people most about recovery after time in ICU

@happytoday73

Those are some very good questions! A lot of relatives will ask how long a patient will be in ICU, and maybe not understand that they will leave ICU when they are stable but not perhaps fully recovered and that rehab can be long. In both the hospitals I have worked in ICU in the patients were followed up on the wards by the outreach team, and the same physiotherapists to continue the plan/make sure its a smooth transition from acute care to the rehab stage.

Rules- prepare for the marathon not the sprint. Everyone wants to be involved and help, but it is good to spread visiting out as that can be exhausting for a patient. Nominate a leader who will organise who visits, speak to doctors and pass information on. Recently a patients NOK created a whatsapp group and asked us to give anyone that rang with enquiries their number and they were added to the group which I thought was a great idea (friends/colleagues/relatives all getting the same info rather than chinese whispers!) Look after yourself, its okay to miss a days visiting (obviously in normal times when you can visit every day) we will always get hold of you if we need to.

Have any of your colleagues caught covid 19? Have you lost anyone? Thanks for all your hard work - from a fellow nurse x

@happytoday73

As for what suprises people, I would probably say its the tiredness. Think about a normal flu or cold, how rubbish it makes you feel with mild infection- and then imagine severe sepsis. You won't have been eating as usual, your metabolic demand shoots up and calorie intake can be hard to get in. Add to that being in bed for days/weeks, I think muscle wastage is about 10% a week as well...so you get tired quickly, and then frustrated. It becomes a bit of a cycle as then long term patients loose motivation as they can't necessary see how far they have come- you learn some motivational techniques!

I'm an A&E nurse and do you ever rethink why you are doing what you're doing?
The last couple of months has made me realise that I'm slowly falling out of love with nursing and I just don't know what to do. I feel stuck because it's so specialised.
Is it just me?

On a scale of one to ten, how scary do you think covid is for us collectively?

Also, how do you stay unparanoid when dealing with all the worst accidents and illnesses?

Thank you for working hard in ICU

@Buzzfrightyears I think one nurse had covid but luckily it wasn't severe, and 2 of our consultants. However it could be more as those are the only ones I have heard of. We have had several healthcare workers admitted as patients but thankfully only for a few days, they all did well. Quite a few colleagues have tested positive on the antibody test which is expected, as they think its been in the country longer than first thought- we may have treated patients with it and never known. Thanks for your work too, it effects us all!

@coffeewithmilk It is 100% not just you. Nursing is very draining, and not really understood or appreciated- by the public or management/government! Its all I've ever done- straight into uni from school, but I do think about retraining or trying something else as it it emotionally and physically tough. Our unit has huge staff turnover and shortages- even before this all began. It can be relentless, and frustrating. I try and see the positives we have- always have work/can live and work anywhere in the UK but it is hard. We always say ICU nursing makes you a jack of all trades, master of none as there isn't really an onward career path to follow unless you want outreach/teaching or management, none of which appeal to me personally. I don't really have any advice but you are not alone, and you do a great job.

Thank you @AluckyEllie
It's nice to know I'm not just the only one. Maybe it's just a phase I'm going through (well so I hope) because when I first went into nursing I loved it. When i found my feet in A&E and moved up the ladder I loved it, but I'm feeling drained and hard to stay positive about it at times.
Hopefully things will get easier and I'll begin to love it again.
Thank you for all you are doing x

How are you?
I feel like everyone is so interested in what it's like and your views to do with covid but after all your hard work i want to ask how you are and how you are feeling and coping?

@labyrinthloafer I'm not really sure about the severity of covid collectively- I'm sure smarter people than me are analysing that constantly at the moment. All I can say is that at the beginning with the news from Italy, the doctors that died and the pregnant nurse in her 30's- it was very worrying and we prepared for the absolute worst. I made sure my husband knew which family member to contact should I become ill, the managers at work were preparing for us to be sleeping/eating/working solidly at the hospital. However, we were fortunate in the area I live in that we were not hit hard. We had to open 2 extra capacity areas but it was never unmanageable. I didn't see any patients that we wouldn't expect to see in a usual winter/pneumonia season (no very young or otherwise fit people.) I think it depends on the area and the population though, as friends who work in London were working at full capacity and very stressed. Currently we are not getting many more admissions....its a kind of limbo at the moment as we keep being told to wait for the second wave, it's like being on edge all the time. I guess its like that for everyone at the moment though!

@coffeewithmilk I am the same, I loved nursing and always had the next challenge- next ward then ICU, then a bigger ICU and a band 6. Now I don't really know what to do next, I want a new challenge but feel I've back myself into a corner with my current skills. Hopefully there is exciting new roles for us both coming soon!

@Scrumpyjacks Thank you, that is so very nice of you. I am fine, I am quite a logical person and try to just take it as it comes. I have worked in ICU for 8 years now and seen some desperately sad situations. I always say to new colleagues when they ask me how I deal with it that it is not my sadness. I sympthasise and will do everything I can to make it easier to bear for the patient/relative but I also hold myself back a little otherwise I think you would really struggle doing it every day. I feel that way with the covid situation- I will do my utmost and work my hardest but I don't take it home with me. Obviously that is easier said than done and here are some patients/relatives/stories that I will never forget.

@labyrinthloafer I just reread and that made me laugh! I try not to be but I do get paranoid as working in ICU makes you think everything is dangerous. My husband rolls his eyes at me. I always worry about him when he is out drinking with friends (and I mean just a casual few) in case someone starts a fight as we get quite a few boozed up head injuries. Or cars- I have a particular hatred of drink drivers as its such a pointless ruin of a life. It can make you think certain accidents are more common than they are as you see them frequently (motorbikes!)

Are many people in ICU conscious? I always thought of it mostly being for people who are in induced comas.

@PinkPlantCase Some people are, normally at any one time about a third. Patients can be admitted for CPAP or hiflow oxygen which they can't provide on the ward, especially if there is a chance they may deteriorate and need sedating and putting on a ventilator. When a patient comes off the ventilator they stay for about 24 hours just to make sure they manage without it (longer if there are other issues etc.) Sometimes a patient will be admitted for dialysis but don't have breathing problems so won't need to be put to sleep. A patient might also be admitted if there is a high chance of deterioration as we are one nurse to one (ventilated) or two (awake) patients and the ward nurses are one to six or even ten.

Thank you for all the work you have done before and since Covid-19.

Did you feel pressure before COVID-19 about how full ICU or step down units and general wards were? Were you fully staffed before the pandemic? I hope that the problems already there get highlighted once the main crisis is through.

@Lockdownlooks Thank you, and to everyone else that said such nice things . We are never full staffed with permanent staff if that makes sense. On a regular shift about 20-30% will be agency or bank (which is staff who are hired by the trust at trust wages and just work when they choose a shift.) I have nothing against agency staff, a lot of ours are regular and I used to work agency (you can't work agency at your own trust) at a different hospital as it was literally twice the pay for a shift and I was buying a house. There is a general countywide shortage of nurses so every hospital has this issue I believe. in regards to pressure the biggest problem- as you have identified was the step down and general wards. We would have wardable patients who couldn't go anywhere as there were no beds. This then meant we couldn't admit patients- and in some cases another patients surgery would be cancelled as there was no post op ICU bed available. It's infuriating. A&E would be struggling, the surgeons furious and we would have these patients almost ready to go home!

Thank you for your phenomenal hard work.

Thank you so much for all you do! Wow 8 years, I don't know how you do it! Following this thread with interest.

I was in ICU on a ventilator for a week after giving birth (contracted bacterial meningitis during c-section). Luckily made a relatively swift and full recovery... Went to visit the staff who looked after me and bring them a thank you card and box of chocolates a couple of weeks after. The consultant looked at me like he'd seen a ghost as couldn't believe how well I looked since the last time he saw me

My Mum was also in ICU/HUDU for 4 months before passing away (I visited most days as lived closest and was NOK).

You all have my utmost respect and gratitude

@OhioOhioOhio Thank you lovely

@AnonUser2018 wow that must have been scary, glad to hear it was over soon. It is so nice to see patients when they come back. I nearly always recognise them by the visitor though as the actual patient looks so different- and you know, in clothes.

You certainly know about the long ICU stays then, it can be so hard and tiring. Hats off to you, you must have been emotionally and physically exhausted. I hope it was some comfort that she was close and you could visit regularly.

What do you think of pubs opening this weekend? I live in a small village and really conflicted between supporting a local business (with common sense plus new procedures in place) for a drink with DH to staying at home.

DH is a police officer so we are already exposed if that makes sense, and not shielding.

@SweetPeaPods I think things have to start opening, and it probably is best to do it in summer when people can be more outside. However, I am certainly not an expert or an epidemiologist and they seem more hesitant about it. We know that they cannot be 100% sure of how things will pan out and hindsight is a wonderful thing...but I do wonder what our next 6 months will look like.