ICU nurse crossing her hands

Challenges in Critical Care Nursing and How to Overcome Them

The life of a critical care nurse, or intensive care unit (ICU) nurse, can be incredibly challenging. ICU nursing jobs require both emotional and physical stamina, and the ability to juggle different variables as they relate to the condition of critically ill patients. Not everyone has the temperament or the discipline for the job, but for those that can manage the hectic pace of the ICU floor, the rewards can be immense.

In order to contextualize the responsibilities and challenges of an ICU nurse and the key skills necessary to overcome those challenges, this article will:

  • Explain the difference between ICU nurses and ER nurses
  • Explain the goals of critical care nursing
  • Consider the core challenges in critical care nursing
  • Explain the necessary skills to overcome those challenges
  • Discuss the rewards of being an ICU nurse

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ICU Nurses vs ER Nurses

The differences between ICU nurses and ER nurses go beyond their respective day-to-day responsibilities. These jobs require fundamentally different temperaments, and someone who has been trained as an ICU nurse might not be able to manage working an ER nurse and vice-versa. However, to the outside observer, these positions may appear deceptively alike. 

ER Nurses

Emergency room nurses treat patients as they enter a hospital’s emergency department. The floor of the emergency room is entirely unpredictable, and from shift-to-shift, there’s no telling what an ER nurse may have to deal with. 

ER nurses often have to treat patients with gunshot wounds, individuals who have been injured in motor vehicle accidents, and patients who have acute-onset symptoms. These situations can range from life-threatening to relatively benign, but the element of mystery surrounding each shift requires ER nurses to be dynamic professionals who thrive in chaos. 

The job is adrenaline-filled, totally unpredictable, and requires the ability to adapt and work quickly. 

ICU Nurses

Contrary to emergency room patients, critical care or ICU patients are often struggling with severe, ongoing illnesses. They have been moved from the general floor to the ICU because of the attention their conditions require. They may be intubated, breathing with the help of ventilators, or affixed with life-sustaining medical drips.

ICU nurses often have a lower caseload than ER nurses, but the patients they work with are almost always in a highly unstable condition. ICU nurses must be incredibly vigilant, monitoring all changes to their patients’ condition while making adjustments when necessary. These nurses strive to impose order on their work environment and enjoy the process of micro-managing their patients’ treatment. 

Goals of ICU Care

Both ICU patients and ER patients may be in unstable conditions, but patients who are transferred to the ICU often require their condition to be micromanaged. Because of this, the goals of ICU care present a unique set of challenges to ICU nurses. 

The goals of ICU care include:

  • Closely Monitoring Conditions: Patients in the ICU may be struggling with multiple life-threatening conditions. This means that ICU nurses must be vigilant and closely observe all changes in their condition, no matter how subtle they may be.
  • Administer Specialized Treatment: Because ICU patients may be struggling with multiple conditions, ICU nurses need to have a deep understanding of how medications may affect their condition and be able to administer treatment accordingly.
  • Provide Constant Support to Patients: While on shift, ICU nurses must remain totally focused in order to ensure patient safety. There are no coffee breaks, because any lapse in attention may prove fatal for a patient.

Core Challenges in Critical Care Nursing

Because of the constant attention that ICU patient care requires, ICU nurses face several difficult challenges. Learning how to deal with these challenges is essential for nurses who want to work successfully in the ICU, and becoming comfortable operating in the environment requires countless hours of firsthand experience to reach that point.

No Breaks

Just like nurses in the ER, ICU nurses must possess incredible physical and emotional stamina to keep up with the pace of the job. They must remain completely focused from the beginning of their shift to the end to ensure patient safety, and be ready to manage any obstacles that may arise. 

Because of these demands, a major challenge of critical care nursing is the requirement to always be engaged, to be “on.” This can be exhausting, especially since the stakes are so high, one or several patient’s lives are frequently on the line, and it can lead to considerable fatigue.  

Compassion Fatigue

Compared to ER nurses, ICU nurses typically manage with a small number of patients at once. However, these patients are often in the ICU for an extended period of time and require constant supervision. Because of this constant, close contact, it’s easy for ICU nurses to become emotionally attached to patients. ICU nurses are often a shoulder to cry on, or a person to confide in. 

However, one downside of this connection is the heightened feeling of loss when a patient does not make it. Unfortunately, because ICU patients are so unstable, this is not an uncommon outcome. Over time, “compassion fatigue” may develop, a condition sometimes called secondary traumatic stress (STS). 

ICU nurses are certainly not the only class of professional who experience this phenomenon; others include lawyers, veterinarians, police officers, journalists, therapists, and survivors of disasters or trauma. But the rigors of ICU nursing make compassion fatigue likely for nurses.  

Symptoms of compassion fatigue include:

Feeling Hopeless: Over time, repeatedly losing patients can lead to a feeling of severe hopelessness, as if the constant hard work being done to help stabilize patients is ultimately fruitless. This, of course, is not the case. But the feeling can be powerful. 

Negative Attitude: Constantly being exposed to death can result in habitual pessimism. 

Sleep Issues: Many ICU nurses who experience compassion fatigue find they have trouble sleeping or may experience nightmares. 

Stress and Anxiety: Constant stress and anxiety are two of the most common symptoms of compassion fatigue. 

It’s important to note that not all nurses experience compassion fatigue and that it’s not a permanent condition. 

Nurse Burnout

According to a study by the RN Network in 2017, more than half of working nurses in the United States have either considered or are currently considering leaving the profession. The study concluded that this is not because the work is not rewarding, but rather because of the amount of work required. When nurses reach this point, the condition is often called “nurse burnout.” 

Factors that Cause Nurse Burnout

There are several factors that lead to nurse burnout, which may include:

Exposure to death. For ICU nurses, death is a constant reality that is either imminent for their patients or inevitable. Spending long, tireless hours working to keep a patient alive, only to have them pass away, can be both overwhelming and stressful. While some nurses are able to compartmentalize this part of the job while tending to dying patients, others find that the repeated exposure to fatal patient outcomes is emotionally draining.  

Long shifts. Sometimes shifts may extend as long as 12 hours and possess little to no chance to take a break. Because patients are subject to constantly changing conditions and ICU nurses are responsible for monitoring their status and making adjustments, shifts can sometimes feel “endless.” 

Grieving family members. Monitoring patients and patient death can be a major source of burnout, but so can the subsequent grief of family members. An ICU nurse is often the first point of contact available to family members, and they may express everything from fear to anger, which the ICU nurse must absorb. 

Symptoms of Nurse Burnout

Symptoms of nurse burnout are often obvious to both the nurse and those around him or her. They may include:

  • Exhaustion: While fatigue is common in most professions, feeling constantly exhausted, even when not working, is not normal. ICU nurses who feel exhausted, even on their days off, may be experiencing a symptom of burnout.
  • Feeling “Checked Out”: Nurses who feel like they are simply repeating the same actions, day after day, may begin to feel slightly “checked out.” They are no longer excited by their job, and what once felt exciting might instead begin to feel repetitive and draining.n
  • Irritability: It’s important to distinguish regular irritability—something everyone experiences from time to time—with chronic irritability. The latter is often a symptom of burnout.

The best way to combat nurse burnout is to identify symptoms as early as possible and to take preemptive action. By adjusting the way an ICU nurse approaches her or his work, it’s possible to approach the job with fresh eyes and renewed enthusiasm. 

Necessary Skills to Overcome Challenges

The challenges posed to ICU nurses are significant, but most people who enter the profession have a greater-than-normal capacity for mental and physical stamina, and find ways to make adjustments. The symptoms of burnout and compassion fatigue are not permanent, and by leaning into the skills that make an ICU nurse successful they can be managed and eliminated. 

Passion for the job. To some, passion for their work might be nice but not entirely necessary. For an ICU nurse, it’s almost essential. 

The ICU floor is challenging and can be emotionally draining, but if a nurse is nonetheless passionate about his or her work, they become able to work through the hard times and savor the good. Often, it’s the little things like a kind word from a family member or a positive change in a patient’s health that a passionate ICU nurse can leverage to find the strength to battle burnout.  

Technical knowhow and ability. To work on the ICU floor requires comprehensive medical understanding and the ability to make judgments on the fly. The deeper a nurse’s understanding of medicine, the more confident she or he will feel when faced with a challenging situation.  

Organizational skills. While organization is important for an ER nurse, for an ICU nurse it’s absolutely vital. Managing several different patients simultaneously, all of whom require different treatments, is a task that demands superlative organizational ability.  

If an ICU nurse becomes disorganized, the chances that she or he will miss a shift in a patient’s condition increases. Organization is not only important in order to keep an ICU nurse on track, but it can also be the difference between life and death.   

Self-care routines. It can be so easy for ICU nurses to get caught up in treating patients that they forget to think about their own health. Anticipating that burnout may occur and taking preemptive self-care steps should be a practice every ICU nurse engages in. 

Rewards of Being an ICU Nurse

While the challenges posed to an ICU nurse may be significant, the emotional and professional rewards often match and exceed those difficulties. While the feeling of emotional reward is subjective and may come from different sources for different nurses, some of the most universal upsides include the following.

Constantly learning. ICU nurses quickly find that no two patients are alike, and what works to treat one might not work on another. This sometimes frustrating truth creates daily opportunities for ICU nurses to learn more about medicine, the practice of critical care, and also how to provide emotional support to patients in need. 

Human to human connection. While some of the most challenging times during a nurse’s time in the ICU result from connections made with patients, it’s those same connections that make the job so deeply rewarding. 

Nurses in demand. According to a study conducted by the Bureau of Labor Statistics, by 2020, the demand for nurses will increase by 36 percent. For nurses who excel in their positions, that means there are ample opportunities for career growth, and also a lot of room for aspiring nurses to find work. 

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