Stop Calling Us Frontline – We are your last resort

In the intensive care unit, patients receive treatment and therapies to prevent them from immediately dying. It’s not pleasant, but it’s true. You don’t want to come see us.

We see the signs and messages. “Thank you, Frontline Workers!” Honestly, it’s confusing. We aren’t your frontline. We are your last resort. And, after eight months, we are tired. Nurses are burnt out. Some organizations did not take care of their employees well when COVID hit. Many nurses are leaving their jobs. Most units are experiencing staffing crises. There just simply aren’t enough nurses to take care of all of you. You don’t want to visit the ICU during normal circumstances. You certainly don’t want to be a patient in one now.

ICU beds usually run at about 70-80% capacity. It’s a sweet spot where the unit can function from an operational standpoint while still having bed availability for emergencies or cyclical unit flow. With the first wave of COVID, some ICUs were operating at 200-300% capacity. The bed crisis in itself wasn’t a huge one. A bed is a bed is a bed. Organizations simply opened more ICUs in other areas of the hospital. It wasn’t pretty or comfortable, but it worked.

The real crisis came with staff. Who was going to take care of all of these extra patients? Organizations employed many strategies. Nurses managed ICU patients remotely, sometimes from other states. Hospitals sought help from staffing agencies and per diem staff. Non-ICU nurses were quickly “upskilled” to the critical care setting. In short, an already precarious situation just became even more dangerous.

Nurses new to the ICU setting usually go through an intense training program which includes classroom and clinical experience and ranges from three to six months in length. Upon completion of this program, they are still novice nurses and rely on their expert colleagues for mentoring and guidance. As crucial as upskilled nurses are, they are still short on education, knowledge, and experience. In our current climate, nurses are working in unfamiliar environments, with a team they don’t know, with fewer resources, fewer experienced staff, and with higher staffing ratios. All of this can and will lead to unfavorable outcomes.

COVID has now been around long enough that we are somewhat in a clinical routine. The patient H&P’s (history and physical) are eerily similar. “Patient attended a family birthday party.” “Patient attended weekly bowling league.” “Masks were not worn.” “Attendees did not appropriately socially distance.” By the time the patient gets to us, they are in bad shape.

They can not breathe without the help of a ventilator. Breathing on a ventilator is very uncomfortable and unnatural. Lung injury in COVID is so profound that patients usually require the most extreme settings, which require heavy sedation and paralytics. If the patient still isn’t ventilating adequately, we will prone them. If their kidneys shut down, we will put them on dialysis. If their blood pressure goes too low, we will put them on continuous medication to sustain life. If they spike an uncontrollable fever, we will put them on an ice blanket. We will bring iPads into the room and update families on the phone. The patient will be alone.

All of this will either work, or it won’t. The average ICU length of stay is 3.3 days. The average ICU length of stay with COVID is 19 days. Prior to COVID, over half of ICU patients experienced post intensive care syndrome (PICS) after their discharge. This syndrome includes depression, anxiety, and cognitive deficits, sometimes limiting their ability to work or care for themselves. The after-effects of an ICU admission with COVID have not yet been studied. Those who don’t get better, will die. In high-surge states, their body will be moved to a mobile morgue because the hospital morgue has reached capacity. Families will be urged not to gather for a funeral.

This grim reality is not your frontline. Your frontline is:

Staying homeSocial distancingMask wearing

Hand washing