Massive Shortage of ICU Trained Nurses During COVID-19 Pandemic: The Need for Cross Training

simba and mufasa

On March 11, 2020, the World Health Organization (WHO) named coronavirus disease 2019 “COVID-19”, a global pandemic (Cucinotta, & Vanelli, 2020). The number of people infected with COVID-19 in the US rose to unprecedented levels in New York City (NYC), New Jersey, and Connecticut hospitals. Many people were hospitalized, were critical, and required the use of ventilators. Intensive care units (ICU) were filled to capacity, could not accommodate the critically ill patients. ICU nurses were outnumbered as well. Hospitals halted elective and emergency surgeries to create room and free operating room (OR) nurses, doctors and other staff so that they could take care of the patients. The OR, same day surgery and any space that could fit a bed and ventilator were converted to ICU units.

Nurses from various specialties with no ICU training found themselves taking care of the critical patients. There was no time to learn, it was sink or swim. Several hospitals hired agency nurses currently practicing and encouraged retired health-care providers to come and fill the void. I witnessed a nurse from the Medical-Surgical unit crying when she was receiving report in the ICU; she was so petrified, she was not familiar with critical care patients. This was not an isolated incident; nurses without critical care experience were overwhelmed yet were expected to titrate medications they were not familiar with in addition to managing patients on ventilators.

Experience as Float Nurse

As a float nurse to all specialties, I was on the frontline taking care of COVID-19 patients and was comfortable in any unit. Working in the ICU, I had three vented patients on multiple drips, tube-feeds in addition to all complex tasks that had to be performed. These patients were very busy and complicated, and they had numerous issues going on and yet making it difficult to minimize exposure by limiting time spent with patient. Due to this dilemma, nurse managers and administrators need to cross train nurses in case of another pandemic that may result in a large number of patients requiring critical care.

Five Benefits of Cross Training

Cross‐training was carried out between nursing staff from L&D and the antepartum unit , outcomes included acquisition of new skills and insights, increased morale, improved overall motivation and collaboration between the units, and improved confidence of staff (Manelski, Wagner, & Norris‐Grant, 2013). According to Lacy (2018), there are five benefits for cross training nurses. Cross- trained nurses have the ability to adapt to various departments, make excellent team- mates, are problem solvers and motivated workers.

1. Increase knowledge

Cross training allows a nurse to take care of patients with different diagnoses and treatments, use different technology and workflows. Exposure to different specialties reinforces and builds upon nursing skills, as a result, the nurse becomes comfortable and intuitive (Lacy, 2018)

2. Anticipate needs to improve efficiency

Cross training allows a nurse to adapt to different teams, learn communication and coordination of different workflows. A nurse is able to anticipate needs of teammates, increases camaraderie building a positive safe environment of both the nurse and patient.

3. Gain better understanding and empathy

As a float to the emergency room, the greatest challenge was to give report to the nurses on other units. Nurses delayed taking report or until the supervisor or manager were notified. Even when nurses received report on time, they would focus on other assessments that could be done later when patient was stabilized. Nurses focus on how busy they are in their department without thinking about situations in others. Cross training provides empathy to understand why nurses need more time before accepting report and to understand situational urgencies in other departments “walk a mile in their shoes” (Lacy, 2018).

4. Become more flexible and adaptable

Exposure to different specialties and situations provides a nurse with some knowledge and experience thus less likely to be stressed by change in patient condition. Previous experience will equip or allow a nurse to make educated decisions.

5. Learn best practices and mentor

As a traveling nurse in five hospitals working in ICU, CVICU, Med/Surgical, Telemetry, SICU and adjunct clinical instructor in 3 hospitals, I have gained experience by working with different nurses. I have acquired knowledge in performing tasks efficiently and share tips with fellow nurses and my students. The continuous learning on the job has strengthened my skills, improved my practice, which is personally and professionally enriching.

Conclusion

Cross training allows nurses to build upon basic nursing skills thus boost their confidence in dealing with patients with different diseases requiring different treatment. Cross training enhances communication skills and team-playing roles reducing stress for everyone involved. Cross training should continue beyond the pandemic, there is nothing wrong with specialization, but flexibility provides a safe and effective environment for nurse and patient.