Am I overreacting?

[OUxPhys, BSN, RN]

I currently work on a cardiac floor (PCU). Recently, our floor was converted to the covid-19 med surg floor (because of close proximity to the ICU was what we were told). Now, my manager says that we are being converted to a secondary ICU to take care of cover-19 ICU pts (in anticipation of the surge) and that we have to take a crash course on critical care. However, I have seen emails that says this class is only for nurses who have recent critical care experience. I have zero years (as does the majority of my floor) of ICU experience. I brought up my concerns of safety and my manager says it doesn't matter, we have to do it.

I have brought this up repeatedly to my manager to no avail. Am I overreacting? In the very same email it has different levels of care. For example, for those who have been away from the bedside for a while and dont feel comfortable taking care of MS pt's that they can be a helping hand. Shouldn't I and the rest of my floor who has no ICU experience get the same luxury of being offered an alternative?

It amazes me how so few of my fellow nurses dont bat an eye at this but then freak out if they get a venous sheath or have a nitro drip.

So my question is: Am I right to feel uncomfortable with this or should I just accept it?

[caliotter3]

I do not think you are overreacting. You have plenty reason for concern. For some, like me, a complete course/training/preceptorship in basic med/surg nursing would be required before pushing us out onto any kind of acute care floor, Covid-19 or not. This isn’t just something they can expect you to roll up your sleeves and pants legs to jump right in without tremendous problems.

[NurseBlaq]

Sounds to me like they're crash course training all nurses to be ICU ready before the Covid storm. It's not a good thing and adds extra stress and burn out on nurses. I'm wondering if nursing schools are going to implement mandatory ICU training in the future to make all students ICU ready upon graduation.

[caliotter3]

Really sad for me because when I was in school, my desired nursing area was the ICU. Ended up between LTC facilities and extended care home health. Never get to an ICU now!

[Nurselexii]

5 hours ago, OUxPhys said:

I currently work on a cardiac floor (PCU). Recently, our floor was converted to the covid-19 med surg floor (because of close proximity to the ICU was what we were told). Now, my manager says that we are being converted to a secondary ICU to take care of cover-19 ICU pts (in anticipation of the surge) and that we have to take a crash course on critical care. However, I have seen emails that says this class is only for nurses who have recent critical care experience. I have zero years (as does the majority of my floor) of ICU experience. I brought up my concerns of safety and my manager says it doesn't matter, we have to do it.

I have brought this up repeatedly to my manager to no avail. Am I overreacting? In the very same email it has different levels of care. For example, for those who have been away from the bedside for a while and dont feel comfortable taking care of MS pt's that they can be a helping hand. Shouldn't I and the rest of my floor who has no ICU experience get the same luxury of being offered an alternative?

It amazes me how so few of my fellow nurses dont bat an eye at this but then freak out if they get a venous sheath or have a nitro drip.

So my question is: Am I right to feel uncomfortable with this or should I just accept it?

What other options do you have?

1. Can you transfer to a rehab unit?

2.will you have an assigned preceptor?

3.can you (anonymously) write your manager’s manager what your being asked to do and how un ready you are?

the nurses who are not batting an eye are afraid to say anything, but share your fears.

the thing is unless they said otherwise I feel like if you make a serious error, you will not be pardoned because you had no formal orientation .

I would ask what their expectation of a short term trained nurse in the ccu is

[MsJenn_The_RN]

2 hours ago, Nurselexii said:

the thing is unless they said otherwise I feel like if you make a serious error, you will not be pardoned because you had no formal orientation .

I would ask what their expectation of a short term trained nurse in the ccu is

This. Right here. Whether or not you feel properly trained, if mgt/admin says "you're properly trained" and you make a big mistake, you're going to be the one held responsible, because that patient was assigned to you. I don't think you're overreacting at all. Definitely find out what the expectations are going to be for you.

[adventure_rn, MSN, NP]

I'm going to have to disagree with the PPs.

Here's the thing. In the next several weeks, you may find yourself in a situation where you have to care for ICU patients regardless of whether or not you've been trained.

I've heard reports of NYC hospitals where the ICU beds were full, so they started putting intubated patients in step-down. Those got full, too, so now there are intubated patients on the floor. All of the nurses (floor, step-down, even specialty areas like L&D and OR who are being floated) are caring for critical patients. You won't be able to refuse a critical care assignment and still have a job because there won't be any non-critical assignments.

Some of the PPs seem to imply that refusing the critical care training will somehow prevent you from having to take ICU patients (by proposing that the hospital is using the training to justify giving you critical care assignments). The reality is that if your hospital is stretched to the breaking point, you'll be given these assignments whether you're adequately trained or not.

IMO, the best thing you can do right now is to get the most training possible so that if you do start to see ICU cases in step down, you will feel marginally more prepared.

This time last month, we were having a discussion on another forum about how to staff for this crisis if hospitals become overrun. I proposed (and still believe) that our best option is for every specialty to 'float up' to the next highest level of training. ICU nurses keep their ICU patients. Step down nurses 'float up' to ICU care, and get a crash course in critical care (since they're the best-prepared of any non-ICU specialty). Floor nurses 'float up' to step-down care. Specialty areas with no bedside contact (OR, clinic, procedural) become helping hands.

This pattern is already emerging in some NYC hospitals.

It's true that a crash course isn't sufficient training to prepare you to take ICU patients. Honestly, the best thing to do would probably be to start preemptively floating staff and cross-training them to the next highest level of care right now while we still have adequate staffing (instead of waiting until we're mid-crisis). Unfortunately, the PPE shortages will probably prevent that.

However, even if you aren't optimally prepared, a step-down nurse in the ICU is better than no nurse at all. Even if patients were to die under your care, I don't think that the hospital would throw you under the bus, or that patient's families could successfully take legal action. If your hospital truly winds up in crisis mode, the expectation is that a lot of people who are hospitalized and intubated with COVID are going to die from it regardless. When you look back at emergency medical care during major disasters (like Hurricane Katrina), there are very few cases of providers being held responsible for bad outcomes unless they were intentionally acting with malice.

[OUxPhys, BSN, RN]

17 hours ago, Nurselexii said:

What other options do you have?

1. Can you transfer to a rehab unit?

2.will you have an assigned preceptor?

3.can you (anonymously) write your manager’s manager what your being asked to do and how un ready you are?

the nurses who are not batting an eye are afraid to say anything, but share your fears.

the thing is unless they said otherwise I feel like if you make a serious error, you will not be pardoned because you had no formal orientation .

I would ask what their expectation of a short term trained nurse in the ccu is

Unfortunately I cannot transfer at this time because there are no positions open anywhere else. As for the training my manager did say I can go to the MICU to learn, however long that may take so I technically would have a preceptor.

2 hours ago, adventure_rn said:

I'm going to have to disagree with the PPs.

Here's the thing. In the next several weeks, you may find yourself in a situation where you have to care for ICU patients regardless of whether or not you've been trained.

I've heard reports of NYC hospitals where the ICU beds were full, so they started putting intubated patients in step-down. Those got full, too, so now there are intubated patients on the floor. All of the nurses (floor, step-down, even specialty areas like L&D and OR who are being floated) are caring for critical patients. You won't be able to refuse a critical care assignment and still have a job because there won't be any non-critical assignments.

Some of the PPs seem to imply that refusing the critical care training will somehow prevent you from having to take ICU patients (by proposing that the hospital is using the training to justify giving you critical care assignments). The reality is that if your hospital is stretched to the breaking point, you'll be given these assignments whether you're adequately trained or not.

IMO, the best thing you can do right now is to get the most training possible so that if you do start to see ICU cases in step down, you will feel marginally more prepared.

This time last month, we were having a discussion on another forum about how to staff for this crisis if hospitals become overrun. I proposed (and still believe) that our best option is for every specialty to 'float up' to the next highest level of training. ICU nurses keep their ICU patients. Step down nurses 'float up' to ICU care, and get a crash course in critical care (since they're the best-prepared of any non-ICU specialty). Floor nurses 'float up' to step-down care. Specialty areas with no bedside contact (OR, clinic, procedural) become helping hands.

This pattern is already emerging in some NYC hospitals.

It's true that a crash course isn't sufficient training to prepare you to take ICU patients. Honestly, the best thing to do would probably be to start preemptively floating staff and cross-training them to the next highest level of care right now while we still have adequate staffing (instead of waiting until we're mid-crisis). Unfortunately, the PPE shortages will probably prevent that.

However, even if you aren't optimally prepared, a step-down nurse in the ICU is better than no nurse at all. Even if patients were to die under your care, I don't think that the hospital would throw you under the bus, or that patient's families could successfully take legal action. If your hospital truly winds up in crisis mode, the expectation is that a lot of people who are hospitalized and intubated with COVID are going to die from it regardless. When you look back at emergency medical care during major disasters (like Hurricane Katrina), there are very few cases of providers being held responsible for bad outcomes unless they were intentionally acting with malice.

I think you are right. What you say does make me feel a little better. I guess I will have to go to the MICU and just see how it feels. If I still feel uncomfortable there may be a chance where I can still take care of the Covid-19 pt's when they move to the new MS ward.

[adventure_rn, MSN, NP]

1 hour ago, OUxPhys said:

Unfortunately I cannot transfer at this time because there are no positions open anywhere else. As for the training my manager did say I can go to the MICU to learn, however long that may take so I technically would have a preceptor.

I think you are right. What you say does make me feel a little better. I guess I will have to go to the MICU and just see how it feels. If I still feel uncomfortable there may be a chance where I can still take care of the Covid-19 pt's when they move to the new MS ward.

It stinks because it's a catch-22. If you agree to cross-train/float, then you'll likely be the first to float or to be assigned ICU patients if they land on your floor (compared to your untrained peers). However, if you refuse to cross-train/float and the hospital reaches a point where everybody is taking critical patients, then you'll be less prepared.

It's kind of a gamble, and there really isn't a right answer. Nobody can predict exactly how hard your hospital will be hit, or what the distribution of resources will look like. The best thing for the hospital as a whole is to train everybody up. However, if only a small handful of nurses volunteer, then those nurses might be setting themselves up to take the crappiest assignments (I.e. the intubated ICU overflow patient in step down), at least at the very beginning.

Either way, you have to do what's right for you. Best of luck.

[LovingLife123]

What my hospital is going to start doing is team nursing which I think will work better. The final details with regards to charting are being finalized.

I as an ICU will take more patients. I currently never take more than two. I will maybe take 4, but have a floor nurse with me. I will assess, manage the vent, and critical drips. The other nurse will do the other things such as regular meds, skin care, oral care, etc. But I will do the charting. And charting on 4 critical patients in the ICU is very tough. I’m hoping they will make our charting a little easier.

It takes months to years to master ICU care. Know that if you take patients on your own, things will happen, and it’s not your fault. When it gets to the point that these patients need intubated, the outcomes are poor.

You can only do what you can do. Keep that going through your mind. It’s something I keep telling myself. It’s how I’m getting myself through.

[OUxPhys, BSN, RN]

1 minute ago, LovingLife123 said:

What my hospital is going to start doing is team nursing which I think will work better. The final details with regards to charting are being finalized.

I as an ICU will take more patients. I currently never take more than two. I will maybe take 4, but have a floor nurse with me. I will assess, manage the vent, and critical drips. The other nurse will do the other things such as regular meds, skin care, oral care, etc. But I will do the charting. And charting on 4 critical patients in the ICU is very tough. I’m hoping they will make our charting a little easier.

It takes months to years to master ICU care. Know that if you take patients on your own, things will happen, and it’s not your fault. When it gets to the point that these patients need intubated, the outcomes are poor.

You can only do what you can do. Keep that going through your mind. It’s something I keep telling myself. It’s how I’m getting myself through.

Our CNS did say that it would be team nursing with an ICU nurse as a resource, which did make me feel better. In this class we learned about arterial lines (which I have experience with at my previous job) and I do have experience titrating nitro (although pressors are a whole different animal). I guess I'm not 100% unprepared but I'm just anxious something bad will happen and my employer will hang me out to dry.

[CVVH, MSN, RN]

4 minutes ago, LovingLife123 said:

What my hospital is going to start doing is team nursing which I think will work better. The final details with regards to charting are being finalized.

I as an ICU will take more patients. I currently never take more than two. I will maybe take 4, but have a floor nurse with me. I will assess, manage the vent, and critical drips. The other nurse will do the other things such as regular meds, skin care, oral care, etc. But I will do the charting. And charting on 4 critical patients in the ICU is very tough. I’m hoping they will make our charting a little easier.

It takes months to years to master ICU care. Know that if you take patients on your own, things will happen, and it’s not your fault. When it gets to the point that these patients need intubated, the outcomes are poor.

You can only do what you can do. Keep that going through your mind. It’s something I keep telling myself. It’s how I’m getting myself through.

We are doing something similar (team nursing with an ICU nurse and a floor/stepdown nurse caring for 3-4 pts), however in addition to dividing tasks appropriately based on role/skill level, we also divide the documentation (and we aren't required to document as much as we normally would due to the crisis).