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Burnout  What role do constant poor patient outcomes play in the pandemic of ICU staff burnout? What if we had a system that supported staff to practice evidence-based medicine? Would a more humane environment and process of care improve our morale? Would improved patient outcomes support staff retention? Liz McQueen, BSN, RN, shares with us how her flame has been rekindled.

Episode Transcription

Kali Dayton 0:00
If we’re going to be talking about humanizing the ICU, then we need to talk about the factors that prevent clinicians from feeling human, especially right now. Even in studies from 2002 to 2007. There have been rates of PTSD up to 20 to 24% of ICU nurses. Those are the same rates as Iraq veterans.

Obviously, those rates have skyrocketed in the past 18 months. Historically, there have been many factors that lead to burnout syndrome or PTSD from clinicians in the ICU, such as being involved in traumatic moments, and factors such as scheduling, interpersonal relationships, and end of life care or ethics involved in critical illness. COVID-19 has flooded our field with seemingly insurmountable challenges and pressures of carrying the world through a global pandemic staffing crisis, unprecedented exhaustion, and the trauma of incessant poor outcomes.

I don’t want to trigger or stir up the trauma you are all currently experiencing. Absolutely the staffing crisis, unethical treatment of hospital systems to their staff, and the public apathy and lack of support to end the pandemic are huge factors, leading to the mental health crisis in a critical care community that studies have shown that the weight of ethical and end of life issues, as well as providing continued care during futile situations can be some of the last straws for ICU providers.

When your emotional and spiritual reserves are running on fumes, you are carrying the weight of massive human suffering, you are doing your best. Thank you for giving whatever morale you have left, and for stain, thank you for showing up every shift and sticking through that shift. Thank you for being patient with each other as everyone has broken burnout and not fully themselves. Thank you for stopping during the rush to hold patient’s hands, and often been the very last person to hear someone’s mortal voice.

Thank you for being the bridge for the family, to their loved ones when you are tired, broken and just want a moment of peace during your shift yet. Can we talk about something really raw, some of you have discussed with me the weight of constantly caring for patients that have become deconditioned zombies in the bed, and then ultimately pass away at painful rates after all of your work in the context of this podcast, that is what I want to address right now. It is likely that our station and immobility practices have fueled some of the heartbreak and trauma experienced by our teams. I recognize that when there’s an impossible staffing crisis and nurses have four plus patients themselves, options become very limited. Yet let’s look at this objective objectively in the context of burnout.

When we automatically, deeply sedate patients, they no longer have their autonomy. We lose human connection with them. We try our best to continue to talk to them know who they are, etc. But it is all one sided. They’re now at the mercy of us and their loved ones to make all the decisions for them. This often creates the crisis of continued care according to the family’s wishes, and against the patient wishes. We stripped the patient’s of their voices and their chance to have the reins in their care. It is a heavy burden to be stuck in that ethical situation.

Our sedation and immobility culture has also contributed to the mass mortality experience during the pandemic. I honor our community and serving, sacrificing and laboring even when good outcomes like excavation, being functional and discharging home have become almost unheard of in our in COVID-19 patients. If I’m understanding correctly, that is part of the desire to leave the field. We are depriving ourselves of the opportunity to see the fruits of our labors when we allow patients to become deconditioned under sedation and immobility.

I don’t hear from our community that they’re burned out of watching patients get better and walk out the door with our practices. We don’t see them get off the ventilator. and walk away on our watch. When you all tell me that 58% of your L techs are not accepting patients, I am hearing that you are left with severely deconditioned tract and peg survivors, that you don’t have the skills or the resources to rehabilitate while simultaneously caring for newly ill patients, you carry the weight of knowing that they have a long road ahead of them, if they make it out your doors.

How would it change your morale to see improved outcomes? How much would your emotional burden be lifted, to be able to have the families connect with patients and have them support each other during the process to know that you weren’t the last person had a conversation with to be able to make eye contact have communication, be able to know exactly what your patient wants and needs and their care, and then watch them walk out the doors of the ICU. In a recent survey on social media.

98% of responders thought that improving sedation and mobility culture would improve morale, and 82% of responders suspected that that would improve staff retention. One of the responders nurse Emily, now known as Miss mobility on her unit has shared with me multiple stories of pushing for mobility patients not always her own, and seeing that she had the power to help prevent tricky ostomies. And to get them excavated.

She reported that that brought her fulfillment, purpose and even excitement during her burnout. Liz, an incredible ICU nurse in Colorado, joins us now to share her renewed perspective during this pandemic. Liz, thank you so much for coming on. And being willing to talk with us about this really difficult time in our history. Hopefully, it’ll be history, someday will you share with us your journey into critical care.

Liz 6:52
I am a new grad nurse in the ICU, I have kind of a longer journey to nursing then than some people took I graduate this is gonna age me but I graduated college in 2004. And I always kind of wanted to go into health care, I thought it was going to be a vet back then worked at some vet clinics decided it just wasn’t for me. And I just I always kind of medicine was always had a special place in my heart.

But I moved to Colorado, I met my husband I you know decided to be a stay at home mom, but the science nerd in me never left. So it was always in the back of my mind. In 2012, we went through a crisis, we actually lost my oldest daughter when she was five. So I had just had my third child, she was three weeks old, when we lost my oldest. And you know, that whole experience was very sudden, it wasn’t something that we knew was happening.

And we lived very, very close to the hospital at that time. And even you know, my daughter was flown to Denver through a helicopter. And when the helicopters would come by and just you know, on another, you know, transporting another patient, I would start to get really anxious and my heartbeat would would race and I couldn’t even drive past the hospital without just having such high anxiety.

And so going through that, and kind of processing all of that I came to the realization that maybe medicine is not for me, I can’t be in your hospital, I can’t be in that environment anymore. It was just too overwhelming. So it kind of got put aside for a while and decided that maybe, you know, I’ll be a stay at home mom for a little longer and see kind of what the future holds, while the future hold held another family crisis in 2016, four years after we lost my daughter, my husband was in a near fatal bicycle accident.

And he was also flown to Denver and you know, that being having to be in a hospital again, and having to be in another ICU room. And being around the nurses and the equipment and the medicine and the pumps and everything that was going on in that room. Thankfully, he was only there for a night and he recovered quickly. But the uncertainty of that I just wasn’t know how I didn’t know how I was going to react to that. So sitting in that room. At first I was very anxious.

But I started to realize, as I looked around the room, as I talk to the nurses, I started to ask more questions. What is that medication for? And I wasn’t trying to be that family. That’s how you know trying to direct care for my family member. But I was genuinely interested. I wanted to know what that medication was for and why they were giving it and what’s coming next and when is he going to be excavated and just kind of like asking every single question that I could In that moment, I realized that not only could I be in a hospital again, but I needed to be in a hospital, I needed to be doing this in my life, it was just, I found that passion again. And every next semester, I started taking my prereqs. So here, I,

Kali Dayton 10:16
oh, thank you for sharing that I can relate to that in so many ways. And I think everyone listening to this has their own journey that led them to get into medicine. I think very few of us just did it for just job security. I think it’s very relatable to have that personal mission and calling in your journey as especially Tinder. Intimate. And I hope that we all know what it’s like to feel called that this is your mission, this is where you belong, was medicine, and ended up being critical care medicine. And that’s why we’re hearing into this. And so straight out of nursing school, you went right into the ICU.

Liz 10:59
It did, yeah, I worked as a tech in my ICU during nursing school. And so I got to see it in the before times a little bit. And that was kind of nice, because I got to see what my coworkers looked like under their mask. So I actually saw their faces and had a little bit of an introduction, probably about three months before COVID really hit within I saw that transition. And I was there through the policy changes in the day to day uncertainty and, and, you know, helping implement all these things that we were doing.

And so I was kind of thankful that even even it was hard, especially through nursing school with everything. With everything that nursing school is on top of working through the beginning of COVID, I was really thankful because it wasn’t just such a shock. When I went into the to the world of nursing, I kind of had a, you know, a ramp up to it. So I was definitely grateful for that. But you know, being a new grad in general is hard no matter where you work, but going into the ICU is also has its own unique challenges.

Kali Dayton 12:06
Absolutely. And I started in the ICU pretty, pretty new, pretty naive, pre COVID. As you were text to get to your license, what did you hope for critical care medicine? What did you think your job fulfillment or your experiences were going to be like,

Liz 12:23
I really liked the challenge that was going to be part of the ICU. I like having to think through physiology. I like getting into the why behind the presentation of my patient. I like really pushing myself and I’m a school nerd, I love learning. And that was part of the ICU appeal for me, just because I knew that I could do so many different things with it. And really, really pushed myself and, and actually live about two hours away from where I work.

And the reason that I did that there is a hospital where I live, but it’s much lower acuity. And while we have a great hospital here, I knew that I wanted to be at that level one, so that I could learn everything that I could get my hands really dirty and just kind of dive super deep into this world. And, you know, that sounds like really great on paper when I’m saying it out loud.

But actually doing it was a bit of an emotional roller coaster Not gonna lie, there were days that I would go to my car and, and cry before I went home. And my preceptor actually saw me cry a couple of times. And thankfully, he was incredibly supportive. And, you know, let me go through that and, and say nice things about myself, because I tend to be pretty critical of myself. But, you know, I had a very good support system, but it was it was definitely challenging, too, especially in the midst of COVID. But you know, I that’s where I wanted to go with critical care is just the intense learning that is involved with it. And having those super high acuity patients was really appealing to me.

Kali Dayton 14:05
And then your unit got overhauled into basically a COVID unit. It sounds like and my understanding is your unit has the traditional culture of sedation and immobility for anyone that’s on a ventilator, correct? Yes, absolutely. And so that was probably exacerbated by COVID. And so what has been your experience as far as caring for these patients and seeing their outcomes?

Liz 14:33
So like, yeah, like you said, I am in a medical ICU. And like you said, basically, it was a full overhaul to take care of these COVID patients, but as far as day in and day out, taking care of pretty much only COVID patients. You know, it gets to the point where you sort of lose a little bit of the humanity of the patient. Like you said they are sedated. A lot of times they’re paralyzed, they’re proned, they’re very edematous, they, they lose what they actually look like in real life. And it’s hard to see past that, and oftentimes actually have to remind myself to talk to them, because that’s very important to me to maintain that connection with whoever it is that I’m taking care of. And I’ve been losing that along the way.

And I’ve tend to sometimes I don’t talk to them, I just go and do what I need to do and get out. But, you know, seeing what it does to a human body, it, they don’t look human anymore. And it’s very, extremely draining to feel the that it’s futile, almost because there’s been so much loss. And, you know, I knew that ICU wasn’t going to be rainbows and sunshine going into it.

But going into it in the middle of COVID, I think has really, you know, increase the amount of death that we see. Just I can’t even I don’t even know how much I don’t have a reference, you know, because this is all I know. But I I feel like we have seen more death and loss in this past year than many nurses saw throughout their career. And it takes a drastic toll.

Kali Dayton 16:17
Yeah. And when you don’t, we feel like his patients are going to die. You’ve never talked with them. Have you ever talked to your COVID patients that were ventilated? I mean, talk to them.

Liz 16:30
Right. Right. I have talked with, I think, three of my covered patients before they were intubated. You know, one was on BiPAP. And one before they even got to BiPAP. And, you know, I can actually name a few that I was probably the last voice that they heard before they were intubated, and they never got off the ventilator. So knowing that I’m that person for them is, I mean, it’s kind of an honor.

But it’s also heartbreaking. You know, we did have one patient, one patient, that I was still a tech when he was admitted to our ICU. And it was before he was intubated. And the first time I took care of him, he was standing at the bedside, he was able to you know, he was telling me about his dog and what life is like at home. And you know, he was self proning. And the next time that I took care of him, the week after that he was intubated, sedated, paralyzed, prone, he ended up having a myriad of things happen to him throughout his course of COVID.

And we had him in our ICU for probably three months, I believe, his total hospitalization was over six months. And he actually was on our local news, because he is now at home, walking with a walker on nasal cannula at home. And it was so rare that someone was at home after this, that he made the news. And just like thinking that, like he’s just such a one in a million, and I got to talk to him before and now I hear his voice after he actually came to the unit.

I wasn’t there. And I’m so bummed because he came to the unit and said, you know, thank you after, you know, he had already gotten home. And I heard just everybody was in tears and just crying. Because it’s just not something that we see. You know, we get thank you cards from families after our patients pass away. We don’t get to talk to them after they leave the ICU.

Kali Dayton 18:35
So what role in this emotional burden does a lack of human connection during their critical illness play on you or on your team? To feel like that last moment before they were intubated was the last time you could connect with them? But what does that do for you to not be able to talk with them and inform them what’s going on or know who they are while they’re on a ventilator?

Liz 19:01
You know, I didn’t think it was really affecting me, as much as I now see, it was while especially during the height of COVID. And as this years progressed, I just, you know, started to develop that dark sense of nursing humor that a lot of people do. And you know, I have this shell and I didn’t realize how thick that shell was getting until I floated to another or other ICU, the neurotrauma ICU.

And I had two patients that were excavated on the same day. So I got to go through that process with them. And then I got to talk to them afterwards. And they actually both ended up transferring out of the ICU that same day. And that is not something that I do. I had to ask other nurses around me. I’m like how do I how do I transfer a patient? What am I supposed to do now? What do I have to do a bedside swallow?

I just didn’t know because I I really only did those things during orientation. And in talking with one of the families I had had this patient over the last two days, or the previous two days. And in talking with a patient as they were leaving the ICU that evening, I started to cry with the family. And I was telling them, you know, I’m so happy for you that you’re transferring. And I’m so excited that you’re getting you know that you’re better. And you’re going on to that next step.

And then I just kind of lost it, I told him, I was like, I’m so sorry, I just don’t get to do this very often. And, and I realized in that moment that it had been so long since I excavated a patient. And they got better. Usually excavation, for me means withdrawing care and holding their hand as they pass away, and being there for the family afterward, and printing their final heartbeat strip for the family. And, you know, getting the grief, like that’s what extubation is, to me, that’s what I have known it to be.

And in that moment with those other two patients, it was just so overwhelming, and I couldn’t keep it in in anymore. And I think that’s what it’s done to me, it’s, I broke my shell. And I it made me realize that I’m not really okay, and I’m not dealing with it as well as I thought I was. And so you know, now I’m becoming more aware of the human. I mean, I always knew that my patients were human, especially going through what I’ve been through in my past and having two of my very close family members in that hospital bed.

And, you know, being on the other side of it. Like it’s always, I’m very, very acutely aware of family and I have a lot of patience, for answering questions and being on the phone. And even when I don’t have time, like I, I take an extra five minutes, so that I can talk to them and reassure them or walk them through this process that is happening with their patient, or with their family member. But I feel like I was losing a little bit of that. And after the experience with this with these two particular patients, I feel like I got a little bit of that back because I got to see my patients awake and talking and smiling and showing me who they are, instead of the family member telling me who they are.

Kali Dayton 22:22
And what does that do for you as far as your burnout and your trauma, to have those moments of connection with your patient.

Liz 22:29
It’s I can breathe a little bit again, it allows me to keep going honestly, you know, it’s hard to be surrounded by end of life every day all day. And then you get that moment that you have a patient that is showing me who they are and talking and laughing with me. And I can take a moment and just remember what real life is like, again, instead of this weird little bubble that we have been living in for the past year,

Kali Dayton 23:06
…and especially starting your career into that all you’ve ever known is sedated, often paralyzed. flaccid bodies in the bed. You’re talking to them, which I just thank you so much for doing that survivors talk about how much that means to them. So you’re doing the right thing. And you’re doing what you’ve been taught and what the protocols of your team and what everyone else has done. And so then we had this webinar, I was brought in to talk to your team about a different way to care for patients.

And I fear and I am aware that it’s probably like a bucket of ice water comes over your head to have all these case studies, pictures, videos of people awake, walking on the ventilator, hi ventilator settings, COVID patients that are walking in their rooms, and then able to be excavated for four days after being prone to paralyzed. What did that feel like? What did that do for you in terms of your burnout? To hear that?

Liz 24:04
Yeah, that webinar, which happened very recently, as we record this, it kind of came at a perfect time for me. I brought like very ironically, I’m actually in a Nurse Residency Program for for my hospital. And we have to do an evidence based project by the end of the year and my group is just me and another ICU new grad. We chose progressive mobility.

Well, here I am thinking progressive mobility for the vented patient looks like a bit of a sedation vacation, dangling at the bedside, laying back down and getting sedated again, that’s that was how I saw it. So to see videos of those patients walking around one was on ECMO that completely blew my mind and, you know, the ventilator settings to I was like this is this is impossible like peep of 14 and they’re walking around?

I mean it was just It completely was shattering to me. And I was so excited. I literally sent you a message like as soon as I possibly could, because I just, I felt reinvigorated. And I felt my passion coming back. And I’m so glad that my my group chose this because now I get to dive even deeper into it. And I’m reading research articles. And like I said, I like learning, but I don’t love reading research articles. It’s kind of dense.

And, you know, I mean, it’s not light reading and but I found myself i On a night shift. And I had gotten all my work done. And I was reading these research articles, like, vigorously taking notes, and just like thinking like, Oh, yes, we can so do this, we like this would be amazing. And we can decrease our delirium, and we can do way better for our patients. And we could have a higher rate of discharge to home and you know, all these things are just flooding my mind. And I’m I finally, you know, the thought of seeing my patients as people and helping direct their own care.

I thought that was also an incredible point that you made. patient autonomy is something that nurses are taught and to really take into account in patient care. But we can’t do that when they’re sedated and paralyzed. And we just have to kind of go with for what the family wants. And you know, sometimes what the family wants and what the patient wants, don’t go together, I’ve definitely found that out. The hard rail as many times with end of life resending of patients wishes kind of a situation happening more and more frequently.

But the thought of having the patient awake and telling me, I don’t want this care, or I want this care, and I want you to be or I’m in pain, and just knowing what my patient is experiencing, would be completely game changing for me, like I am, like, excited talking about it.

Kali Dayton 27:02
And it’s so nice to hear that kind of spark and excitement and someone that has been drowning in a COVID unit during what 18 months of the pandemic, that is, that is what I hope this message brings. I recognize, I get emotional, that are good people have suffered so much. And institutions have treated our nurses and all of our staff, poorly. There have been bad decisions made poor policies implemented and maintained.

They’ve been dumped on by the public. It’s been, it’s been completely unfair. And those are things that we can’t reverse, we can easily change right now. And I don’t mean to bring this new process of care as a way of another burden. My hope is that it would be received the way you’ve received it, with hope that we’re reconnected to why we got into medicine, that there can be hope that we can successfully excavate our COVID patients or any patient on a ventilator, that they can walk out the door that they can direct their care, communicate, that we can connect with them and have more than just flashing zombies in the bed, that we can have fulfillment and our careers again.

And I love that you’re digging into the research. I love that that’s why have the blog and all these studies on the blog so that everyone can read for themselves because it’s so compelling. And that’s when we really learn that this approach to care that I’m advocating for is evidence based. And I think once nurses really dive into the evidence, then they’re gonna have the same reaction that you’ve had as to this is true, this is feasible, and this is the right thing to do. And I hope that we can heal from the burnout, through improving patient care. What’s the next step for your team?

Liz 28:56
Oh, that’s a big question. I, you know, you talking about how hospitals have kind of treated the staff that’s at bedside and, and, you know, obviously I see it every day and and just this week, I learned I have two more of my nurses that are leaving and like, we can’t literally every day for the last two weeks, I’ve gotten a text saying that we’re short staffed, we need help, you know, it’s constant.

And I think, you know, the the thought of bringing something like this, that could help with that burnout and have this process changed, like you said, you know, it could be seen as a burden. And I think there would have to be a very huge cultural change to really get this going. And everybody would have to be on board nursing nurses day shift night shift, the physicians, the PT OT, RT, like everybody is going to have to think about things very differently because you know, traditionally a patient is over breathing the vent, or they have those high vent settings, what’s the first thing that we all say?

More sedation, more sedation, more sedation? So I think, especially for new grads who don’t know anything else, it’s gonna be really hard to shift that. But, man, what if we did? You know, what would that look like, I just I get excited thinking about it. Because, you know, maybe we wouldn’t be so burned out, maybe we could have higher retention, maybe we could be that team, again, who, you know, comes together for our patients. And, you know, it’s not just the neuro trauma side that’s gonna see our patients excavated, and, you know, awake and walking around with PT, it could be us, too. It could be COVID patients, too, it would look different. But it could be.

Kali Dayton 30:53
No, I definitely believe that every patient is different. But we’re not treating them all differently. We’re not adjusting our care for their capacity or with a big picture in mind. I also think that administration would have to get on board to when we’re in the staffing crisis, I’m hearing about units, having nurses having four patients each, that is not a good situation, to foster this culture of walking our patients. I think that it’s not as laborious as we expect. If we properly walk our patients, then it’s going to take two or three people, not the seven, and the lift and all the equipment that we anticipate, nonetheless thought

Liz 31:30
about that too. Actually, I’m sorry to interrupt you. Because I, I was thinking that too, in in how could we start this thing, and it puts a little more burden on day shift, because they’re already day shift is so busy. And I have the unique advantage of seeing both day shift and night shift where I work, I flipped back and forth. And so I know, the challenges of each shift.

But you know, what was it like proning patients in the beginning, it took six of us to prone patients…. six and seven. And we didn’t you know, we had a plan, but we weren’t practiced at it. And now we can flip a patient with as little as four people and you know, we know exactly what we’re doing. And it’s so fast. And, you know, I think in the beginning, yes, it will be the exact same thing to get a patient up, it will take a lot of people and we will be you know, a little clumsy with it and kind of trying to figure out how to make this work. But I think once we get it down, it’ll just be like pruning, we’ll just be like, Alright, it’s time to get up. Oh, that’s

Kali Dayton 32:31
such a good point. Because I’m coming from this perspective of a pretty well oiled machine, a team that’s done this for 20, almost 30 years. And it is so deeply ingrained in the culture that no one really bats an eye at it. And it’s just, it’s almost like muscle memory for them. You know, they took the test tube to the IV pole, like Nepali to the gown or you know, like those menial things may be a big deal initially trying to figure out, how do we have the oxygen tanks ready on the ventilator, those kind of tasks.

But I know that it can become as quick and as easy as you’re talking about you. That is such a good example of pruning. Because everyone was freaking out over pruning initially. And now with experience, it flows. And I’ve I’ve had patients, few patients that have oxygenated better walking them prone. So crazy to me, you know, we’re presenting to everyone, but how, how beneficial is that? I mean, we we know that it’s beneficial, but which is more beneficial? We don’t know until we try both, right and allow them both options. So I digress. It does take good staffing ratios.

I’m coming from a perspective of two patients to one nurse. But when you have four patients to one nurse, and everyone else is short, and it just that is a huge barrier. I have a webinar for administrators to show the financial benefits of supporting this process of care. So as they hire more PTS, or retain their nurses and maintain this kind of culture, they’re financially going to benefit from it, because we’ll get into another a bunch of other episodes, but nonetheless, just know.

So yeah, when we understand the evidence, we can fight administration with the evidence, we can make our case and show by speaking their language with dollar science and utilizing the evidence that shows that improved care improves revenue and treating our staff better will actually improve their bottom line. And I think that seems to be a perspective very last by administration. nurses that have the skill set of talking to their patients and getting their patients up and actually getting them better are going to be invaluable and not dispensable as they’ve treated them. So I have strong feelings about this.

And I think all of this plays in to the burnout right now. Our teams have been treated poorly, and they have been unable to provide optimal care to the best of their ability. And that’s a huge burden. You guys have been deprived of the ability to see patients for who they really are, and have that joy of connecting with patients that even got you into nursing, right? You have not been able to watch people get better and have that human touch and connection, and that’s been stripped from you.

So thank you for being open to believing that this can change. Thank you for staying, and for pushing through and caring for patients for talking to them, even if they’re not talking back, for speaking with their family members. And for and during the trauma. I still have hope and excitement for the future of critical care medicine. But we have a lot of healing to do. What would you share with teams that are experiencing the same that you’re experiencing?

Liz 35:56
It could be different for different teams based on their particular experience? And that’s a hard question. Actually, I think, you know, for me, like I’ve said before that spark came with this potential shift in the way that we are treating patients. And, you know, I think we’re all, especially right now, in this moment of history.

I think we’re all in this era of routine, that we still have COVID patients, and yeah, we’re we’re not necessarily afraid of COVID, because we’ve kind of been there done that. But we’re not really doing anything differently. We’re not really trying many things different at this point. And, you know, just as far as the vaccine is out now, and I think for us, it’s a little harder at this point, because some of these illnesses could possibly be preventable by a vaccine, and people are choosing not to get the vaccine, which is their choice.

Obviously, I’m not saying anything to that. We’ll leave that for a different discussion. But you know, I think finding something is is going to have a little bit of a shift. I think we all need a shift right now, I think we all need to try something different and look at things differently. Because right now, it just feels so monotonous. And like I said, so futile, that just the idea of changing the way we do things has it brought a light back in me and I think it can bring that light back to units across the country.

And I just like, I have never heard of an awakened walking ICU before now. And now I’m like, Alright, let’s do this. And every single hospital like, I want to see this, I want to still be a nurse when this happens, you know, and I don’t know what that would look like. And I don’t know what that would take an I’m not an administrative type person. So I think it would be a learning curve for a lot of people.

But I just, I can just picture it, I can see it and I can I can hear news stories about it. And you know, we’re having more recovery from COVID We’re having, you know, there’s no more nursing shortage crisis, there’s, you know, I just I can I can just see it. And I think if we can make a shift in any way, I think it can bring back a lot of hope. And like I said, a lot of light to hospitals everywhere.

Kali Dayton 38:42
That would avoid a lot of the burnout. And nurses are feeling this pressure to do sedation vacations and take off sedation, and they’re made to be the bad guys. When we have these protocols that set them up for failure. We’re immediately starting sedation, and we causes huge mess of delirium. And then we turn to the nurse and say, be a good nurse, let them wake up because that’s the right thing for them.

Oh, and hear your other three patients on ventilators do the right thing that is completely unfair and not feasible. It has to be completely demoralizing if we were supporting nurses and had appropriate staffing ratios and had protocols in place to prevent the delirium that would make everyone else’s job so much easier. And even if you’ve never seen it before, it feels right. And I don’t think that’s just a vain hope.

That’s nursing instinct. It feels right. It resonates with the logic you’ve been taught throughout your training to hear and application principles of mobility, humanity, ethics, patient autonomy, evidence based practice, everything that should feel right to us, no matter what our experiences have been. And at the beginning of a COVID When everyone is running to do all these antibody and hydroxychloroquine trials.

We were running to find this magical drug for this. Yet we were quickly intubating people and deeply sedated them right away We were conducting studies on medications trying to improve mortality rates. And I could run my head through the wall, saying, yes, let’s find good drugs that helps us process. But let’s not simultaneously turn our backs on what we know, does improve survival rates. Yet, that is exactly what we did.

So we shouldn’t be just as excited about the prospect of improving mortality rates with things that we have studied and have proven to improve survival and all other outcomes. We shouldn’t be more excited about that than any prospective drug right now. Because early mobility, and minimal sedation has already repeatedly shown powerful capacity to save and preserve lives with patients with ARDS and acute respiratory failure.

We already have all the evidence, we just have to put it into practice. So I am so grateful that there are good nurses out there diving into the research. I know that change will come because you’re out there doing it. Thank you so much for all you’re doing and sharing. Hang in there. Everyone. Hang in there. Stay with us. It will get better. The Dawn will come because you’re bringing the change. Thank you.

Liz 41:12
Yeah, thank you.

Transcribed by https://otter.ai

 

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