Table.
Comments from the interdisciplinary team on team dynamics, stressors, and other experiences in the intensive care unita
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Interdisciplinary dynamics
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| Team dynamics: |
| “A lot of times, I don’t feel like I’m heard … I don’t feel like my opinion is valued or respected…. A lot of times it comes from doctors on my floor.”—Female, registered nurse, 3 years ICU experience |
| “I think pharmacists are in a position where we provide advice but it’s very easy for people to just say, like, nope I don’t like your advice; I think it should be different … you have to just sit and take it…. It takes away my feeling of autonomy, I guess … it degrades my feeling of worth because no matter what I say, somebody is totally able to just be like, I don’t want to do that…. ”—Female, pharmacy, 5 years ICU experience |
| “You feel like you’re getting decisions handed down from above that don’t always make sense … difficult to practice when it doesn’t make sense…. Shared decision making is no longer … they talk it, but they don’t do it”—Female, registered nurse, 25 years ICU experience |
| “The thing that I like [about working here] is collaboration … some [of the doctors don’t] believe in that … they treat … some other health care professionals not equally”—Male, respiratory therapist, 13 years ICU experience |
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Team dynamics of the code environment: |
| “When everybody does their role … the flow seems to be good. It’s very organized chaos”—Female, registered nurse, 7.5 years ICU experience |
| “I feel the most stress if I’m in a code and there’s no set roles.”—Female, registered nurse, 3 years ICU experience |
| “The only time it’s a problem is if the room is … super chaotic and people are talking over people and nobody’s listening … you just need to crowd control and get people out of the room that don’t need to be there”—Female, registered nurse, 3 years ICU experience |
| “It’s like the room is always too small for the number of people who are in there”—Female, pharmacy, 11 years ICU experience |
| “It’s sometimes difficult to obtain … the control and get people to focus on what you need … especially if there are too many people in the room.”—Female, physician, 5 years ICU experience |
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Work stressors |
| Administrative burden: |
| “I don’t like my inbox”—Female, physician, 3 years ICU experience |
| “I don’t enjoy all of the associated paperwork … it takes away from the joy of actually treating the patient.”—Female, physician, 5 years ICU experience |
| “[I don’t like] the more logistical and paperwork side of things … it feels like you’re just doing menial tasks”—Male, physician, <1 year ICU experience |
| “The things that I don’t like are policy-related … the back-end work of order entry and things we can’t change.”—Female, pharmacy, |
| 3.5 years ICU experience |
| “Although we don’t punch a clock, it’s essentially 40 hours of patient care … then anything additional that I do is just bonus … you do a lot of discretionary effort to make up 60 or 80 hours a week to get that work done.”—Female, pharmacy, 5 years ICU experience |
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Family interactions and moral distress: |
| “Some of the patient population … their manner, sometimes, isn’t always respectful … that kind of burns you out a little … ”—Female, registered nurse, <1 year ICU experience |
| “It can be really draining … if the family have a lot of questions or they’re not communicating with each other … or they’re mean or rude”—Female, registered nurse, <1 year ICU experience |
| “Sometimes it’s stressful … you might feel some moral distress … you feel like you’re prolonging death. Maybe patients that you think should be comfort care or palliative care patients … maybe this isn’t in the best interest of the patient”—Female, registered nurse, 9 years ICU experience |
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Time limitations: |
| “It seems like there’s not ever enough time to get all your stuff done”—Female, registered nurse, 2 years ICU experience |
| “There’s so much pressure to get work done that it’s to the point where I feel almost unsafe”—Female, pharmacy, 5 years ICU experience |
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Code emotions: |
| “If I have a patient that doesn’t survive … I have a really hard time … if it’s a really young patient … or if the patient is super, super old and we shouldn’t be coding them, I really have a ton of moral distress with that.”—Female, registered nurse, 3 years ICU experience |
| “If it was somebody that was a younger adult that was doing really well and then, all of the sudden, wasn’t and there was nothing we could do, that would be kind of hard”—Female, registered nurse, 3 years ICU experience |
| “If it’s … somebody that was not trending that direction, or it’s a very young person or, you know, a very acute change … that can definitely add to the stress.”—Female, physician, 3.5 years ICU experience |
| “Especially if a patient is young, it’s hard … when we see a 40-year-old, well I can certainly relate … it’s difficult.”—Female, pharmacy, 11 years ICU experience |
| “I think it just depends … on how invested you are in the person that you’re caring for.”—Female, physician, 5 years ICU experience |
Abbreviations: ICU, intensive care unit.
a
Stressors in the intensive care unit varied among interdisciplinary team members. Nurses had more stress from family member interactions and moral distress. Physicians and pharmacists accrued more stress from documentation and administrative burden. Meanwhile, most team members agreed that there was not enough time to complete their daily tasks in an effective manner, and this contributed to their stress. Additionally, codes added to work stress, especially if there were unexpected deaths or the patient was especially young.