Through the eyes of nurses: A look at COVID-19 care in the ICU

Carla Yost, System Chief Nursing Officer for Ascension Via Christi in Wichita, KS writes about COVID-19 care in the ICU.

Unit nurses Terri Pletcher and Tiffany Nold

"You have the power to make COVID 19 go away."

I was filled with emotion as I said these words during the recent taping of a public service announcement about the importance of getting vaccinated.

They made me sad as I thought about our nurses and other care team members and what they lost or had to give up during this almost 2-year-old pandemic.

Last week I got a closer look at the sacrifices they are making as I rounded in the Medical Intensive Care Unit where many of our patients with COVID-19 are receiving care.

Before entering, as I put on an isolation gown, N-95 mask, and all the other personal protective equipment, I paused and reflected: Unlike the nurses who serve in this unit every day, I have a choice whether or not to enter.

As I enter the unit, I am greeted by Terri Pletcher, a registered nurse with more than three decades of experience, and Tiffany Nold, the new graduate she is mentoring. I ask, and Terri readily agrees to let me shadow her for the next couple of hours so I can get a glimpse of what she sees during a daily shift.

We go first to the room of a patient on a ventilator whose disease progression is evidenced by an increasing heart rate and need for oxygenation. The patient has a poor prognosis yet, is a full code, meaning all life-saving measures will be performed, even if the outcome is grim. For some patients, the nurses struggle to engage the family; still, they continue to encourage them to maintain contact with the patient via iPads and devices provided by the hospital.

Family separation is an increasingly challenging part of the nursing role as they assume the role of surrogate family. "We are often the last person the patient sees as we hold their hand as they pass," Terri says. While families can step away for hours, days, or even altogether when the emotions become too raw, the nurses cannot.

Other family members are highly engaged, like those of the patient in the next room. He is in his 50s and in obvious distress. His wife calls to encourage her husband to cough, take deep breaths, and lie in the prone position. He is receiving anti-anxiety medications as he is fearful of not being able to breathe. Like most of the patients in the unit, he did not get the vaccine.

Terri tells me that watching patients suffer a premature death is particularly painful, especially when a vaccine might have prevented them from becoming severely ill.

I ask Terri to tell me more about what she’s seeing. COVID is different from what she has experienced over her 30-plus years in nursing, she says. With COVID, the patients may have been well, working full time and enjoying family events just two weeks prior to being admitted to the hospital. "Then they have difficulty breathing and we get them in the ICU," she says. The rapid progression of the disease is devastating to patients and families as it gives them little time to prepare and process.

With COVID, the number of deaths is triple what even seasoned nurses like Terri typically have seen. "We often know that if we code someone or have to put in an endotracheal tube and put them on a ventilator, their chances of survival are very low," she says, adding that it’s emotionally exhausting to experience deaths, sometimes as many as five in a shift, day after day.

I ask Terri what keeps her coming back. Behind her eye shield, tears stream down her face as she says, "It's hard, but I am a nurse. I care and caring is what I do."

At that moment, the most I can offer Terri is a hug. I do not begin to understand what she and her teammates are going through. All I know is that I want to support her in any way I can. And, honestly, I feel guilt, as maybe I should have done more. But, like many other nurses, Terri was the one at the bedside, every day, every situation, and intimately dealing with the emotions of teammates and family members.

Tiffany, the graduate nurse, has been relatively quiet, except to say that she sees the emotional toll that COVID 19 is taking.

As a fellow nurse and as the system chief nursing officer, I worry about the new nurses like Tiffany and the long-term effects the pandemic might have on their careers.

As an optimist, I hope Tiffany will have a long career at Ascension Via Christi. Despite the tumultuous beginning, she is surviving and learning from the brave and heroic examples of her fellow nurses and clinicians.

Terri tells me that Tiffany is going to make a great nurse. "I never thought this would be what I would experience my first few months out of school," Tiffany says, adding that she hopes she will be able to provide care the way her preceptor does.

As I leave the unit and remove my layers of PPE, I am grateful to have had this experience. Our nurses deserve to be recognized for their selfless sacrifice and incredible courage.

They have overcome their fear and continue to be at the bedside, caring for others in ways that only heroes do.