Some days as a Critical Care Nurse it seems like a lot of people are coming to the ICU. On a Sunday night, close to change of shift, it appears that errbody is being admitted there. In a critical care setting you see all kinds of patients, and varying degrees of illness. Motor vehicle accidents, sepsis, overdoses, respiratory distress, Myocardial Infarctions. Anywhere from guarded to stable, and whatever falls in between.
But occasionally you’ll get a stable patient who doesn’t quite meet the requirements for intensive care nursing, and since we’re so darn likable there’s a lot of times that patients want to overstay their welcome in the critical care setting.
Critical Care Nurses thrive in an uncertain environment. Action is our oxygen, and give us an intubated patient any day of the week. Heck, give us two of them. We love taking care of critical patients, and definitely love making them well. If you need to be in ICU then we’ll work for you.
Sometimes, though, the lines get blurred between what’s appropriate ICU criteria and what’s not. So here’s a cheat sheet I came up.
You may be ready to leave the ICU if…
- When you know your pain medication orders and schedule better than your nurse.
- When your family has been present long enough to obtain a staff ID badge or paycheck (or even if they act like they have).
- When you can get up out of bed by yourself and unhook all your monitors.
- When you’re stable enough to come off all monitors for a five hour test in nuclear medicine.
- When you complain continuously about the menu.
- When you request to have your nails done by the staff.
- When your blood pressure is better than mine.
- When you’re well enough to bring up chronic health problems you haven’t felt worth dealing with on an outpatient basis.
- If your “hypertensive crisis” is resolved after one dose of IV Lopressor.
- When you walk down the hall to visit with other patients you’ve come to know well.
- Just about anytime you leave AMA.
- When your main concern for the morning is getting your make-up on.
- When an order for telemetry isn’t a necessity.
- When you not only know all the nurses’ names, but their kids’ names too.
- If an IV isn’t necessary to maintain!
- When you can keep track of your own intake and output.
- When you can, and do, push the call button for requests more than four times in an hour.
- If your “respiratory distress” is relieved after applying 4L O2 via a Facemask.
- When you’ve memorized all the TV channels.
- When you can move across the room faster than your nurse.
- When you can sufficiently entertain more company in your room than we have nurses on the unit.
- If you’re not actively bleeding with your GI bleed, your blood pressure is perfect, and your H/H is probably better than mine right now at 6 months gestation.
- When you order out pizza for lunch.
- When you update your Facebook status Q1 hour.
I know the atmosphere is divine, but eventually you have to tearfully say farewell to the trusty ICU staff. After all, leaving critical care is a good thing. It means you’re getting better, and you’re on the pathway to recovery.
As a physician, your patient’s transfer to MedSurg means eventual discharge. We appreciate your faith in us, but it might be time for your patient to bid us ado. So don’t be surprised when we ask.
Basically if a patient is not ventilated/sedated and they’re hemodynamically stable then we may raise an eyebrow.
Remember ICU doesn’t equal sitter service or a place to keep someone overnight to prevent the phone from ringing. When in doubt refer to the above list. If the patient meets 1-3 of the above then they might be ready to leave the ICU.
As ICU nurses we take great pride in the thorough and skilled care we provide to our critically ill patients, and we love to see them get better. But then it’s time for them to go.
The bottom line is there’s no greater reward for an ICU nurse than to see their smiling patient wheel out of the unit in better health than when they arrived, and we also celebrate with the patient when they’re well enough to not require being here.
meltedflowers says
Well written. Don’t worry u ever get me in I u..I am always ready to leave..I was in icu last year with my pneumonia….. I have been in icu many times in my life…I hate it…I hate the constraints I hate it.. hate all of it. I am not an easy patient I guess.. don’t Luke to ask for help and I will tell you I am fine when I am not…just so you will release me. Because I am afraid. …… as a patient it’s scary….as a family member of patients..over time….it’s scary…so never fear…the o my thing u will see from me is ..Well me trying to escape…. or a hidden candy bar, because the food sucks. Ha……..pray for me…I need it.
April J. says
I have been an ICU nurse for over 16 years now, and see this all too frequently. Then the next thing you know, the ER is crying for an ICU bed that is truly needed. It’s not fun having to call MDs in the middle of the night to get orders to transfer their patient out of ICU (they probably needed to go days ago) because the bed is desperately needed.
brieann.rn@gmail.com says
Yep. You’re preaching to the choir. ?