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?
I was just discussing this with a physician friend yesterday. Healthcare professionals are being asked to practice in areas we aren't trained or qualified to work, but there's been no broad-scale discussion of legal/licensure protections, to my knowledge.
My Board of Nursing has a decision-making model to help nurses determine if an assignment is within their scope. Every nurse has an individualized scope based on years of experience, areas of expertise, education, specialty certifications, conditions they're experienced caring for, type of facility worked in, etc. There's a 0% chance that I could safely care for a vent patient right now. It's not in my scope. Reading a crash course online module wouldn't change that.
We all know that we are (rightfully) subject to legal/licensure ramifications if we practice outside of our scope, yet here we are. Employers are telling nurses to unsafely practice beyond their scopes and that it's not an option, but boards of nursing aren't offering protections.
I would like to hear "We understand that nurses are being asked to do dangerous things right now, and nurses are being asked to practice beyond their scopes. You won't be punished for trying to help." Nurses are already being asked to practice without physical protections. At least they deserve pandemic-related license protections for peace of mind.
I think the best you can do is quickly take your manager up on the offer to crosstrain in the MICU with an experienced critical care nurse before your unit converts to an ICU. Ask for a list of the most common drips, and study them extensively on your own. Try to learn all you can about concerning assessment findings, complications, and lab values in COVID patients, related nursing interventions, warning signs that a vent patient is worsening, etc. You still won't feel ready, but you'll be as ready as you can be.
The whole situation is unfair to patients and nurses alike, but as the system gets overwhelmed, I'd rather have a PCU/cardiac nurse caring for me than a newborn nursery or psych RN. (I promise that's not a knock against nursery or psych RNs at all. I just mean you are about the best possible back up option in this scenario to a true ICU nurse.)
I like the team model discussed in a previous post and can see that being much safer and effective.
Specializes in Neurosciences, stepdown, acute rehab, LTC.
On 4/5/2020 at 6:51 AM, 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.
My thoughts exactly. This is a disaster situation so it’s different from normal training. They have to use their staff to max ability. At my unit, they are offering ICU cross training while our unit has low census pre- storm. (It’s not mandatory though ). I was told my stepdown would be partially Covid ICU soon, but that ICU nurses would handle the vents while we handled other patient care. I’d still much rather have the training than not in this circumstance. I don’t think refusing training will help the situation.
Staff are resources. The healthcare system is very diverse in the roles each department plays. In times of crisis they need to reconfigure those resources to meet the new demands. It isn't fair to ICU staff to be overloaded while others have regular loads.
Yes you should be concerned. This is a crisis, and that's why you are being asked to do something you are not normally supposed to do.
Specializes in Perioperative, peds ,floor nurse,scl nurse.
When I started in nursing, your job was where you were assigned. My first job was in the peds burn unit & then I was transferred the the Infectious disease unit & although I didn’t love it, it would never have occurred to me to ask for a transfer because it just wasn’t done. I even caught something from one of the patients in spite of vigorous handwashing & strict isolation technique. I can easily understand why nurses are afraid because the possibility of catching something from the patients is very real. It happened to me. And if anxiety is interfering with the ability to do quality nursing, then if you can transfer out, do so. I went straight back to my infectious disease unit without a second thought. When I was offered the opportunity to cross train to different units, I took it. Because I hated being pulled to a another unit where I was unsure about what was going on. The cross training came in handy during job searches with even an increase in starting pay. But I can relate to nurses being forced to take on critical patients if they not comfortable doing so. And with the way things are, with poor ppe availability, & huge patient influx, I don’t blame nurses being frightened. I can’t encourage cross training enough. But nurses should not be made to put their licenses in jeopardy to do a job. And to all my sisters on the frontline, we were anointed to take care of God’s children. We will do our very best !
Not overreacting at all....I'd be calling my union rep immediately here in the UK but I don't know how or even if you have any unions that protect nurses. In all my years of healthcare related jobs I have always been told that you do not touch anything unless you have been given full training and deemed competent. I agree that those of you with no ICU experience should be used in a more appropriate area. It makes no sense to force people into roles they are not trained nor competent in. It will only result in serious mistakes. It would not be a shock to see many of those nurses hand in their immediate resignation either.
Not overreacting at all....I'd be calling my union rep immediately here in the UK but I don't know how or even if you have any unions that protect nurses. In all my years of healthcare related jobs I have always been told that you do not touch anything unless you have been given full training and deemed competent. I agree that those of you with no ICU experience should be used in a more appropriate area. It makes no sense to force people into roles they are not trained nor competent in. It will only result in serious mistakes. It would not be a shock to see many of those nurses hand in their immediate resignation either.
I work for a government hospital and we do have a union but it is a weak one. The good news is I think I heard my CNS say that we have 68 nurses with prior ICU experience so that makes me feel better.
I work in ICU. We were told this was our surge plan also. In our unit the PCU nurse will have an ICU nurse who will also receive report on the PCU nurse‘s patients and overseeing those patients also. I’m going to assume leadership will attempt to give most “stable“ patients to the PCU RNs. But we all know how that goes. So the ICU RNs will be responsible for four covid ICU patients.
Procedural nurses with critical care backgrounds (cath lab, IR) are being floated to units when the surge comes. Same concept of team nursing -1 primary ICU RN + 1 ICU RNs for 3/4 pts. We are considered helpers so we do not have own our assignment. He owes ICU Nurses with no CVICU background won’t responsible for ballon pumps, LVADs, ECMO etc but can help with anything else.
Your not over reacting. I would run away very fast personally. ICU course/training takes a good 4-6 months. A crash course doesn't sound very safe. Plus, you won't feel comfortable working in an ICU for a good year or so. It's very different from medsurg/telemetry. You now are faced with 2 options. 1) Is to take the risk or 2) Quit. Tough decision. Good luck
My unit is fairly well-staffed right now but we pull in people from cardiac stepdown to team with CVI RN's. The cath lab nurses are fantastic because they all have CC backgrounds. We preplanned for the possibility of having to use med surg nurses by offering a mini critical care course which I teach myself and I can be the resource for MS nurses myself when they do come. I don't assign them balloon pumps, LVADS or ECMO but they can usually handle the drips.
Specializes in critical care, PCU, PACU, LTC, HHC, AFC.
On 4/4/2020 at 9:13 AM, 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?
You have a right to be uncomfortable if you weren’t I would be worried.
I am afraid this is happening to hospitals all over. They are doing the same thing in my hospital. They are combining PCU/ICU together (basically there is no more PCU at this time)
They are mixing up the staff as well so some ICU nurses go to PCU (to help the PCU nurses with the critical pts) & some PCU nurses go to ICU to learn how to care for the ICU pts. This is not for training theses nurses are taking an assignment of a critical pt they have never cared for before. This also stresses the ICU nurse who has to care for their pts & help the PCU nurse with their assignment.
I felt this way the past week we had a pt who needed CRRT - I have no CRRT experience & no one in my unit did. I got a crash course 15min handoff/report & the pt was ours. To say I haven’t felt like we were in a dangerous situation is an understatement.
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I was just discussing this with a physician friend yesterday. Healthcare professionals are being asked to practice in areas we aren't trained or qualified to work, but there's been no broad-scale discussion of legal/licensure protections, to my knowledge.
My Board of Nursing has a decision-making model to help nurses determine if an assignment is within their scope. Every nurse has an individualized scope based on years of experience, areas of expertise, education, specialty certifications, conditions they're experienced caring for, type of facility worked in, etc. There's a 0% chance that I could safely care for a vent patient right now. It's not in my scope. Reading a crash course online module wouldn't change that.
We all know that we are (rightfully) subject to legal/licensure ramifications if we practice outside of our scope, yet here we are. Employers are telling nurses to unsafely practice beyond their scopes and that it's not an option, but boards of nursing aren't offering protections.
I would like to hear "We understand that nurses are being asked to do dangerous things right now, and nurses are being asked to practice beyond their scopes. You won't be punished for trying to help." Nurses are already being asked to practice without physical protections. At least they deserve pandemic-related license protections for peace of mind.
I think the best you can do is quickly take your manager up on the offer to crosstrain in the MICU with an experienced critical care nurse before your unit converts to an ICU. Ask for a list of the most common drips, and study them extensively on your own. Try to learn all you can about concerning assessment findings, complications, and lab values in COVID patients, related nursing interventions, warning signs that a vent patient is worsening, etc. You still won't feel ready, but you'll be as ready as you can be.
The whole situation is unfair to patients and nurses alike, but as the system gets overwhelmed, I'd rather have a PCU/cardiac nurse caring for me than a newborn nursery or psych RN. (I promise that's not a knock against nursery or psych RNs at all. I just mean you are about the best possible back up option in this scenario to a true ICU nurse.)
I like the team model discussed in a previous post and can see that being much safer and effective.