Introduction
Roughly 1 out of every 3 patients in the Intensive Care Unit on average, are unable to communicate.
Because of this, the role of an ICU nurse stretches far beyond providing nursing care alone. They also act as advocates, or voices for the voiceless to ensure that their patients' needs, rights and wishes are heard, recognized and respected.
In doing so, these warriors in scrubs essentially embody the very essence of healthcare: compassion, advocacy, and unwavering commitment to patient welfare.
I'm Jon Haws, RN, CCRN Alumnus and Founder of NURSING.com. In this article, we will look at the crucial, yet often overlooked, role of advocating for patients who can't speak for themselves. I'm also going to share a few personal stories that I experienced on the ICU floor while working as a nurse at one of the busiest hospitals in Dallas, TX.
Understanding the ICU
Welcome to the heart of critical care, the ICU. In this unit, the battle between life and death unfolds rapidly every day, and at the forefront of this battle are heroic nurses that navigate these circumstances daily.
The ICU provides critical nursing care to people that have life-threatening injuries and illnesses and, as a result, are in an increased state of vulnerability during hospitalization.
This unit typically sees a staff-to-patient ratio of about 1:2, featuring a highly-trained, specialized team with access to advanced medical resources and equipment that is often not commonly accessible elsewhere. Patients with rapidly deteriorating conditions are often referred to this unit straight from the ED (Emergency Department) or right after high-risk surgery. In the United States, roughly 10% of all hospital beds can be considered intensive-care beds.
To truly grasp the challenges and rewards of the ICU, it's crucial to understand the common conditions treated here such as:
- Sepsis or septic shock
- Trauma from road accidents or burns
- Acute heart failure
- Stroke
- AKI (Acute Kidney Injury)
- Pneumonia
- Acute Pancreatitis
- ARDS (Acute Respiratory Distress Syndrome)
- Poisoning
- Gastric bleeding
- Surgical complications
The heightened vulnerability of patients in the ICU magnifies the importance of not only medical & nursing expertise, but also advocacy.
The Nurse as the Patient's Advocate
In the ICU, nurses become the unsung heroes, acting as the patient's first and last line of defense. As the ICU nurse assigned to compassionately watch over a patient in distress, you typically would be the one spending the most time with your patient. More so than other healthcare professionals or even their family members.
This special position that you're put in allows you to pick up on and understand nuances that may otherwise be missed. You are in such a unique position to advocate for a patient’s comfort based on observations.
Advocacy in the ICU extends beyond just completing nursing tasks.
Oftentimes, family members of the patient may fall divided on an overall care plan. Being in the ICU, by definition, means a loved one is in critical condition. For families, it sometimes means that there's a very high chance that their loved one may not walk out of the hospital. So, when that's the case, tempers and emotions are high and having to make big decisions on a care or treatment plan could cause division within the family.
That's where you would come in. Advocacy involves ensuring the patient's comfort, respecting their rights and previous wishes, and, at times, mediating between family members with differing opinions on the plan of action.
Advocating for our patients means educating ourselves too. To effectively advocate for patients, nurses must continually educate themselves on evolving healthcare ethics, patient rights, and communication strategies. Staying informed empowers them to navigate complex situations, ensuring the best possible outcomes for those under their care.
During my time as a nurse, I found myself intertwined with the stories of many patients and their families, however, there are a few special situations that I found myself in that have always stuck with me throughout the years, where I had to advocate for those who came across my watch. I would like to share those stories with you to really help put all of this into perspective and hopefully help you on your nursing journey:
Story #1: Poorly Placed Chest Tube
There was a woman who had a surgery and a chest tube inserted that was poorly placed.
She was in grimacing pain the moment I arrived on my shift. The physician who had placed the chest tube was a neurosurgeon with limited experience placing chest tubes and I knew something wasn’t right. These tubes should not be causing so much pain for the patient. Although it was night time, and this was not a life threatening complication, this patient was unable to get the day shift nurses and physicians to complete an X-ray to verify placement or to examine why it was causing so much pain.
As the shift progressed, her pain grew to such intensity that she was unable to open her eyes, move, or even talk - she just grimaced. I woke the on-call physician and requested an X-ray to confirm placement. Despite the fact that confirming placement could potentially indicate the surgeon had made a mistake, I insisted. In the end, the tube was in fact, placed too high and was nearly puncturing her lung.
The options were weighed and we were able to get the tube removed. The pain immediately went away and the patient was finally able to rest. In the morning, as I was preparing to leave, she stopped me and said, “Jon, you were like an angel last night. Thank you for caring for me.”
Story #2: Unassuming Chest Pain
A young man came into the ICU after a car accident and he appeared to be in good health apart from his injuries from the car accident. When I went in to complete the beginning of shift assessment, he complained of some chest pain.
So I listened to his heart. I was still a new nurse, but this sort of chest pain and abnormal heart sounds, coupled with the fact that he was young and in good health, although subtle, was obviously concerning.
It did seem to be minor, but despite this, I called the physician and said, “he's complaining of some chest pain and he just had a car accident [trauma]. Is there any chance we can run a quick EKG on him?”
We ran the EKG and found that he was actively having a heart attack!
Interventions were immediately put into place to save this man's life.
Story #3: The Stubborn Surgeon
One night while working on the code team, we got a call over to the med surg floor for a post-op patient who was suddenly having a hard time responding and the nurses were unable to place a new IV. When we arrived, there were two nurses in her room and the plastic surgeon who had performed a bariatric surgery earlier that day. Upon a quick assessment and a review of labs, it was determined that the patient was actively hemorrhaging internally in her gastric region, which was the location of the surgery.
My code team partner and I immediately began to request blood products and attempted to start new/larger IVs in order to administer the blood. This patient was deteriorating very rapidly, so we spoke to her surgeon and requested the patient be transferred to the ICU immediately. He refused, not wanting one of his post-op patients to be moved into the ICU. As we waited for the blood, we also requested a rapid transfuser to be sent from the ICU and I began attempting to start new IVs.
When the blood arrived, I had barely inserted a 20 gauge IV, I mean, just barely into her vein. She was desperately low on fluid volume and finding a good vein was all but impossible. We connected the blood products, but they were not infusing fast enough. The rapid transfuser had still not arrived and the patient was now unresponsive.
We again told the surgeon that this patient HAD to be in the ICU and once again, he refused!
At this point, there were 4 nurses and 1 physician in her room at her bedside and this is on a med surg floor! My partner and I decided we would attempt using a pressure bag to infuse the blood more rapidly. He pumped up the bag while I continued my attempt to find a better vein. The bag of blood tore and blood began flowing out of the bag and onto the pressure bag. My partner removed the blood from the pressure bag and climbed on her bed. Holding the blood above the patient, he began to squeeze the blood into the IV. During this time, I was looking for any new veins and trying to awaken the patient. Meanwhile, the surgeon stood at the foot of the bed, still not wanting to move the patient. It was at this time, we told him, “THIS PATIENT IS GOING TO THE ICU!”
I called the surgical ICU and requested a bed and they quickly made a room ready for us. Although the surgeon still did not want to move the patient, we unlocked her bed and told him she was moving and needed more intense care if she was going to survive. He FINALLY relented at this point.
My partner climbed fully onto the bed squeezing the blood, and I began running down the halls of the hospital pushing her bed. When we arrived at the ICU, the new room and nurse were ready to receive the patient and provide her with the care she needed. The next evening, I went to check on this patient and she was fully awake and had received all the care she needed. Being a good nurse doesn’t always mean being subservient. It means giving the patient the care they need to culminate in the best outcome.
Taking Advocacy to the Next Level: ICU Nurses Breaking the Mold
In the ICU, we're not confined to bedside duties alone. We're stepping beyond those bounds, elevating our advocacy efforts. Picture us as a united force, collaborating with various healthcare professionals. Engaging in ethical discussions, we navigate through complexities, contributing our insights to policy development. Our advocacy isn't limited to the bedside; it permeates every corner of the healthcare landscape, ensuring the paramount importance of patient well-being.
Ethical Dilemmas: Advocacy Edition
Picture this: ICU nurses diving into the twists and turns of ethical dilemmas. Advocating for patients means wading through tricky choices – like the tough calls on end-of-life care, organ donations, and when to say, "Let's pull back."
Juggling these ethical knots adds layers to our role as advocates. It's a total balancing act, respecting patient wishes while gunning for the best outcomes.
Embracing Technology: A Revolution in ICU Advocacy
The role of technology in the ICU advocacy landscape is nothing short of transformative. From electronic health records (EHRs) to telemedicine, these tools are revolutionizing how healthcare professionals communicate. Beyond merely streamlining patient care, technology serves as our invaluable ally, ensuring we remain well-informed, document thoroughly, and champion evidence-based practices. In essence, technology acts as our dependable sidekick, keeping us at the forefront of our game and ensuring quality and continuity of care.
The Rewards and Challenges
Working in the ICU is a wild ride – tough, but seriously rewarding. You've got these amazing ICU nurses who basically become the superheroes, being the voice for folks who can't shout out for themselves.
The compassion that is shown by ICU nurses as they strive to remain a voice for the voiceless is not lost on the patient or their families!
Navigating through these mega complex medical puzzles, making big calls, and championing for top-notch care – that's the secret sauce of being an ICU nurse.
In a Nutshell
Okay, wrapping this up – being an advocate in the ICU is like wearing a million hats. These stories I spilled give you a peek into the epic challenges and victories of ICU nurses – our very own healthcare superheroes. So, as we throw confetti at the compassion, dedication, and sheer superhero vibes of these healthcare legends, remember: Advocacy isn't just a job. It's our kick-butt responsibility that's the heart of the critical care nursing game.
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Happy Nursing!
