Carry With Us 

How an ICU Nurse Lives his Life while Shaping Ours

The digital clock blinked at 3 a.m. in a wood-paneled house in Cumberland, Maryland. The cabin, rattled by late October weather, creaked throughout the night. But the sounds of an old, settling house were not what woke 23-year-old Ryan Thomas from a cold sleep. Thomas, a surgical trauma intensive care unit nurse (STICU) and volunteer paramedic, bolted upright amidst a night terror, which he started having after he began working as full-time healthcare provider. Regardless of his quality of sleep, he continues to work 12-hour shifts at University of Virginia (UVA) Medical Center in Charlottesville, Virginia. 

“I don't know if this is the picture of being a nurse that was painted to me in nursing school. I was just bright-eyed and bushy-tailed,” Thomas said. “Sometimes, it’s just not what I signed up for, and I hate saying that out loud.”  

Thomas was born in Loudoun County, Virginia, and grew up with his parents, Stacey and Dave, and two younger brothers, Michael and Matthew. Thomas is 5’9 and looks youthful, younger than 23. He has brown hair and brown eyes, which squint when he smiles. He cares deeply for those around him, who often comment he “has no flaws.” Which, of course, he disagrees with. 

Thomas spent his time in high school working on the student council, taking Advanced Placement (AP) courses, and volunteering as an emergency medical technician (EMT), taking certification classes three days a week for six months straight. One night, Thomas shadowed Jamie Stephens, a fellow EMT and emergency room nurse. Thomas admired his bedside manner, respect for patients, and ability to navigate difficult situations. 

“I was supposed to leave that night having learned something about EMS, and I definitely did. But I left with more than anything else realizing (Jamie) is who I want to be when I grow up. I had never had that feeling or epiphany before,” Thomas said. 

Thomas graduated from the University of Virginia’s Nursing School in May 2020, and began working in the surgical trauma intensive care unit (STICU) in August 2020, one month before his original start date in September. In the United States, the average age of nurses is 51 years old, and only 9% are male, according to the National Council for State Boards of Nursing. 

“I just didn't want to be a doctor. I wanted to be a nurse. I wanted to be at the bedside. I wanted to be doing the busy work. I wanted my hands dirty,” Thomas said. “Nurses and respiratory therapists are honestly the ones doing a lot of the backbreaking labor in healthcare right now.” 

The STICU houses patients who are undergoing transplants, surgeries below the diaphragm, or have recently suffered from trauma. UVA Medical Center serves as one of five of Virginia’s Level One Trauma Centers, or facilities that can provide any possible services 24/7. Thomas and his co-workers often remind themselves they see “rare occurrences” within the medical field, even if they constantly have patients in their unit. From severe car crashes and motorcycle accidents to fence posts penetrating eye sockets, the “rare occurrences” that nurses in the STICU experience can still be traumatizing.  

“My experience so far is that almost every day, you show up and work is fairly traumatic,” Thomas said. “We talk about PTSD and veterans who go overseas and have one incident that can scar them for life. We don’t talk about first responders … you literally show up every day and just inch by inch are traumatized.”

Despite a potentially traumatic work environment, the demand for nurses continues to grow due to an aging population and increased access to healthcare. The United States Department of Bureau and Labor Statistics predicts a 7% growth in nursing jobs from 2019 to 2029, which is faster than the average rate of 4%. 

Despite the growth, the United States is still projected to experience a shortage of nurses, and a study from Georgetown’s Center on Education and the Workforce suggests that more than 1 million retiring baby boomer nursing professionals – coupled with 23% of nurses over the age of 55 reducing their volume of clinical work – could exacerbate the need for new graduate nurses. 

“I've seen so many nurses leave in the last three months that it kind of makes me concerned for what my future looks like. They're young and some of them are doing it because they're advancing their career. But some of them are like, ‘I just don't want to be here anymore’. I just don't want to get to that point,” Thomas said. 

A 2020 Gallup poll found that, for the 18th year in a row, the public ranked nursing as the most honest and ethical profession, with nearly 85% of people claiming their standards of nurses are “high” or “very high.” But not all patients treat nurses with the same kindness taken in polls outside a hospital environment. 

Alison Okerlund, nurse manager of the surgical trauma intensive care unit and the surgical trauma intermediate care unit, has seen all types of patients in the STICU and has seen firsthand the challenges that trauma care can present. 

“You don’t often have patients who can talk to you. You don’t often have patients who are kind to you. The front lines go through so many things and they have to stay a patient advocate, even when they are not treated kindly,” Okerlund said. 

Thomas has experienced both positive and negative interactions with patients on the front lines. 

“In the ICU, some of your patients are sedated and intubated, but you still have people awake who are just less than pleasant. Nursing school taught me that I should take that, that people in those situations have the right to be upset,” Thomas said. “The transition to the real world has been a really difficult one.” 

When he first started as a full-time healthcare worker, Thomas began providing care for different types of individuals throughout the Charlottesville region, many of whom are unaware of the daily struggles nurses throughout hospital units face. 

“I don’t think they realize what we take home with us when we leave. I don’t think they realize the things that we kind of like carry with us because of us taking care of them,” Thomas said. “I think the world has come to know that no matter who you are or what you've been through a nurse is always going to have your back at your worst time.” 

Thomas began having night terrors after his first shift in August and hasn’t slept well since. Each of his shifts lasts 12 hours, starting at 7 a.m. or 7 p.m. When home, Thomas struggles disconnecting his brain from the hospital mindset, attributing his constant focus to nurses being “110 % ‘on’ 14 hours at a time.” 

Thomas’s strenuous mental, physical and emotional adjustment to becoming a full-time healthcare provider is not isolated. Today, nurses are called on to provide more for patients, particularly during Covid-19 pandemic.

“There’s quite a sacrifice that people are making to show up to work, more of a sacrifice than I think nurses have made in the past. Quite literally, you could get sick and die, or get your family sick just by showing up to work. There’s really something to be said for the things that nurses are never going to ask for, but that they really need,” Thomas said. 

Before each shift, Thomas fills out a symptom survey on his phone. At work, patients entering his unit must be swab tested for Covid-19 by a nurse wearing personal protective equipment (PPE) before treatment. He has spent time convincing patients to get tested, reiterating hospital policy, instead of tending to other aspects of his job. Though he doesn’t work directly with patients who have tested positive for Covid-19, the pandemic is omnipresent in the hospital atmosphere.

Thomas’ experience as a new graduate nurse during the pandemic is not isolated to new full-time healthcare providers or his particular unit. An April 2020 World Health Day Press Conference, led by United Nations Secretary-General Antonio Guterres, discussed the sacrifices and struggles that nurses have faced nationally due to the pandemic. 

“We have seen unprecedented levels of overwork by nurses, particularly those specialized in intensive care units, those in management or those most directly involved in the response to the Covid-19 pandemic, oftentimes without adequate time for rest and recuperation, without support and assistance, with limited considerations for their mental health and well being,” Guterres said. 

In the STICU, Okerlund said that despite the resiliency and teamwork in the unit, the pandemic has affected everyone. 

“I think for a lot of us, the rapid change and the constant flexing and pivoting was exhausting. It was a constant feeding of new information. I’m like, ‘What do we do today? Because yesterday was different,’” Okerlund said. “When I asked what their stressors were, it was a lot of ‘We don’t know what’s going to happen. There is no end point. We don’t know what this is going to look like.’”

This past year, the STICU received nine new graduate nurses, including Thomas, who adapted to working full-time on top of navigating coronavirus restrictions and regulations. 

“For new graduate nurses, it takes a lot of strength and resilience to make it through because there is such a large learning curve that lasts for two to three years until you get a level of expertise and comfort enough to have seen enough to get there. It’s a stressful situation in normal times without Covid,” Okerlund said. 

Mental and physical health of nurses, particularly in their early career, can be greatly affected by stressers, like an overwhelming career start or chronic stress, according to a 2020 study by the Karolinska Institute. High levels of fatigue can be exacerbated by a lack of stability within the healthcare system, particularly during the pandemic. Nurses, especially new graduates, are highly susceptible to exhaustion stemming from Covid.

“Nursing hasn’t been ‘normal’ in COVID. The new graduates who have come in the time of COVID-19 haven’t really seen what it’s like to have stability within the health system. We’ve been pivoting so much and changing roles, that shared governance where they can be involved in decision-making has been put on pause,” Okerlund said. “They haven’t seen a normal culture within the unit. They’ve just learned in the time of COVID-19, which has been a major stressor on top of just learning the basics of our patient populations.”

Thomas, whose early career has been shaped by Coronavirus and consistent traumas within the STICU, experiences newfound levels of fatigue. 

“I knew that this job would be tiring, but I’ve never known this type of exhaustion. Just like physically drained, morally strained, just emotionally cut down,” Thomas said.

The Karolinska Institute found that high levels of burnout in early working life can significantly affect the frequency of symptoms like cognitive dysfunction, depression and impaired sleep. Nursing burnout is described as “a phenomenon conceptualized from chronic workplace stress that has not been successfully managed that is characterized by: energy depletion or exhaustion, lack of motivation or mental distance from one’s job and feelings of frustration that may lead to reductions in work efficacy.” 

His education may have emphasized the importance of taking care of yourself, but Thomas feels he never learned what causes nursing burnout. His coworkers, he said, don’t willingly talk about their experiences with nursing burnout. 

“I wish we could have talked to nurses who had burned out, so that we could understand what they had gone through because frankly, nobody can spend that much time in the setting I’m in. It’s that exhausting all the time,” Thomas said. “Everyday you show up and it’s traumatizing and it’s just normal.”

The prevalence of nurses reporting high levels of burnout symptoms within the first three years of working is 12.3% , which could potentially increase the nursing shortage worldwide, according to the Karolinska Institute. Thomas’ senior co-workers have offered words of solace throughout his first few months in the STICU.

“It’s almost kind of like tough love, and they’ve been super supportive, but it’s been like, ‘Everybody goes through this’, you’ll live, your skin will toughen up. It’s not going to be this bad all the time,” Thomas said. “It’s reassuring, but I don’t love the feeling.” 

To avoid long-term negative consequences for nurses’ health, preventative measures should be introduced early to new nurses, potentially as part of nursing education, orientation periods or onboarding programs. Additionally, Thomas supports broader legislation and societal changes, like mandated breaks, safe patient-to-staff ratios, and better benefits.  

“I feel like the answer that I've seen time and time again is that we need legislation. We need better pay and we just need more respect from the people who we support as the backbone of healthcare. A lot of people have jobs because we do a really good job,” Thomas said.

Thomas has worked under the advice of a preceptor, a 26-year-old nurse named Jackson, since his first shift in August 2020. On December 15, he finished his orientation period and gained more control over his work schedule. Though he loves Jackson, who always finds ways to celebrate each day's small wins, Thomas is excited to have a more stable routine. 

“You have to grab onto those good moments, and carry those with you to know that the challenging days aren’t every day,” Okerlund said. “Even on our hardest days, there’s positives that come out of it, which is our team and look at what we did.”

Thomas’ contract in the University of Virginia’s STICU lasts two years, the minimum amount of time he can stay while on good standing with UVA. Currently, he’s planned to stay on the unit for four to five years, as long as he can “keep his sanity.” After working several years in the STICU, Thomas hopes to become a flight nurse, or nurse who provides pre-hospital emergency critical care via helicopter. 

“I really want to master being a nurse in this unit. I knew this coming in, but it’s been nice to hear from more seasoned nurses that the unit I’m on is truly one of the most critical care units we have,” Thomas said. “I feel like if I can master what it means to be a STICU nurse, I’ll feel like I have what I need to go to the next part of my journey.” 

Until then, Thomas’s life will continue to be characterized by early mornings and late nights, his routines mirrored depending on the time of his shift. He’ll wake at 4:50 a.m. or p.m., allowing himself 10 minutes to welcome the day or evening. He’ll shower, grab his UVA embroidered white robe, and pick his favorite scrubs, the gray ones, on a lucky day when they’re clean. His black vest, bearing UVA’s orange “V” and “STICU”, will cover his scrubs. Compression socks and tennis shoes are crucial, keeping his blood circulating properly during 12 hour shifts. Pens, safety goggles, and his “Ryan T'' nametag become staples of his wardrobe. Breakfast, lunch, dinner, whatever time of day, is made. Snacks packed. And he’s out the door, on the 30-minute walk to work that helps him greet the night or day like an old friend. 

“I feel incredibly lucky and accomplished to be in such a role where at 23 years old, I’m showing up to this crazy job,” Thomas said. “All people, all walks of life, are looking to me to help them and I’m actually able to do it. That does mean a lot to me. I try not to forget.”