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

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COVID-19 turned many hospital units into ICU outnumbering the number of ICU trained nurses. Nurses from different units were mandated to take care of critical care patients without ICU training. AS a result, cross-training to ICU will solve this dilemma. This article describes the benefits of cross-training so that nurses are prepared and will not be subjected to such a situation in case of a public disaster or another pandemic.

Has 17 years experience.

What's the importance of cross training for nurses?

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

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.

References

Cucinotta, D., & Vanelli, M. (2020). WHO declares COVID-19 a pandemic. Acta bio-medica: Atenei Parmensis, 91(1), 157-160.

Lacy, M. (2018). 5 Reasons nurse can benefit from Cross training. Nurse Recruitment
Manelski, M. J., Wagner, S. P., & Norris‐Grant, D. M. (2013). The Pearls and Perils of Cross‐Training: A Collaboration of Antepartum and Labor and Delivery Room Nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42, S51-S52.

World Health Organization. (2020). Assessment of risk factors for coronavirus disease 2019 (COVID-19) in health workers: protocol for a case-control study, 26 May 2020 (No. WHO/2019-nCoV/HCW_RF_CaseControlProtocol/2020.1). World Health Organization.

Munya Rwakonda has a PhD in Nursing Philosophy and Nursing Education from Walden and graduated in 2017. I am also adjunct lecturer and clinical nursing instructor at a community College. I am a nurse with 16 years of experience, worked in ICU/CVICU the past 10 years and worked in NY with COVID patients. I am aslo a travel nurse in ICU?CVICU/Tele and Medsurg. Munyaradzi Rwakonda, Phd, MSN, CMSRN, CVICU/RN, Adjunct Nurse Educator, Travel Nurse

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46 Comment(s)

A Hit With The Ladies, BSN, RN

Specializes in Psych. Has 5 years experience.

I used to work in ICU. In fact, I trained in medical ICU throughout my RN Residency program!

I don't recall ICU being hard, per se, just incredibly busy. I used to think just how much work I did every single hour on a shift, and wished one could itemize billing for all those nursing tasks! Later on I moved on to inpatient acute hemodialysis, and then to psych (which I'm in now).

I used to miss ICU from time to time but wouldn't really ever consider going back. It's just too much work really for the pay. Not worth it to me.

simba and mufasa

Has 17 years experience.

Thanks for taking the time to read my post, so grateful I can talk to nurses around USA. Yes, ICU is not difficult, just busy, but you need to know how to titrate drips and prioritize your tasks. Nursing is weird, ICU/CVICU and any other unit, u get paid the same. I strongly believe that nurses should be cross trained and have the basics in case of another pandemic. Sometimes units match your personality as well. Good luck in your psych unit, I am also contemplating change to psych as well but I have ICU as a foundation.

Thank you

A Hit With The Ladies, BSN, RN

Specializes in Psych. Has 5 years experience.

Why thank you for posting it! It was a very well-written article! And I do agree with you on cross-training! 🙂

scribblz, BSN, CNA, LPN

Specializes in Med Surg, Tele, Geriatrics, home infusion. Has 14 years experience.

I think proactively cross training across comparable specialties (especially in the times we live in) only makes sense. IE if you have a few smart and motivated step down/ PCU nurses cross-train them for ICU... Same for tele medsurg nurses, cross train them for PCU.

@munyaradzi rwakonda sounds like you are a great resource for those around you! I'm happy to step outside my comfort zone if I have a resource person to give me a quick overview to start me off and then answer any questions that may come up over the course of the shift.

I think it's important to cross train only those motivated to do so; someone who's resistant to change and has extreme anxiety about it is not the best candidate. Every place has people who are content where they are and those who are more restless and get bored without a challenge. It's OK to be whichever one you are, and I think actually strengthens your staff by allowing for both continuity and flexibility.

Thanks for sharing!

Runsoncoffee99

Specializes in Peds. Has 17 years experience.

I think a better idea is to implement more of a team nursing approach.

I wrote about this before,but a hospital in my area asked my agency for nurses that were experienced with ventilators. The plan was to have the agency nurses work exclusively with the ventilators and other respiratory issues. That would have freed up the ICU nurses to do other things.

Many of my coworkers were eager to help out.

Many on here were against it,but as I read AN,I think many posters believe that nurses working outside of the hospital setting are brainless.

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

10 minutes ago, Runsoncoffee99 said:

think a better idea is to implement more of a team nursing approach.

Hi, I don't know if this is BETTER idea, but sometimes it works. I was sent to the ICU to do team nursing a couple of times ( I am a PCU nurse), and my experience was 50/50. I was assigned nursing tasks: transfuse blood, overlook CBI, check glucose every hour on the dot, etc. It was OK if the ICU nurse was respectful, but other times, they treat me as if I was a tech incapable of assessment, and were downright rude. So, it depends. Team nursing can work, other times - not so much.

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

On 6/25/2020 at 8:54 AM, Runsoncoffee99 said:

Many on here were against it,but as I read AN,I think many posters believe that nurses working outside of the hospital setting are brainless.

With all due respect, that is a very generalized line. I, for example, am mystified with outpatient positions, I don't know how they do it, there is not much back up to count on. I would never think of outpatient nurses as "brainless".

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

20 hours ago, munyaradzi rwakonda said:

I strongly believe that nurses should be cross trained

Same here! Thank you for the post! I am looking into that for next year when I'm done with BSN.

Unless there is a commitment on the part of the employer regarding the training part of "cross-training," this easily becomes just another way to pretend that people should be fully competent with fewer exposures and without a real orientation. It is primarily a way to make staffing not look as bad on the surface.

Crises are crises and require extraordinary adjustments. But, long-term, the type of cross-training that a lot of employers seem satisfied with is not supportive of nurses' professionalism and our expectations of being able to move from novice to expert. Employers are satisfied when someone can absorb all the stress onto themselves and manage to get by.

Ideally the cross-training would be undertaken before a crisis. And ideally it would be its own program of providing a structured orientation to the cross-trainees. However, a lot of what is called "cross-training" is really just spending a few shifts in a different area doing the gopher/"go-for" role and or performing nursing assistant tasks and basic nursing tasks. I really think nurses have more to offer and deserve better. I understand that employers would prefer to have a bunch of jack-of-all-trades nurses, but what usually goes along with that is "master of none." I don't think, generally, that this is a philosophy for nursing that we should aspire to.

If there is a commitment to provide reasonable training so that nurses can confidently and competently serve a couple of different areas that share skill and knowledge sets, that sounds like a good idea.

RichlyBlaq, ASN

Specializes in ICU, CCU.

I agree with the idea of cross training across specialties. It allows you to utilize skills you probably don't use on your home unit and decrease the need to rely so heavily on travel nurses. I'm not trying to take assignments away from travel nurses but my ICU was overwhelmed and relied so heavily travel nurses....still does, to be honest. The one food thing they did was bring in nurses from other units to be "assists" to the ICU nurses. They shared responsibilities and worked together to care for multiple patients. One of the nurses is even planning on joining our unit.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

On 6/25/2020 at 12:20 PM, RichlyBlaq said:

I agree with the idea of cross training across specialties. It allows you to utilize skills you probably don't use on your home unit and decrease the need to rely so heavily on travel nurses. 

But then that brings up issues of competency and the requirement to ensure that adequate time to maintain competency in all units. There’s the saying jack of all trades, master of none. In non-crisis times, would we be doing the right thing for quality patient care by requiring nurses to work in multiple specialties and having to change up skills constantly? Sure, some specialties are similar, but when you’re taking OR nurses and throwing them into med-surg, it’s a whole other world. And when those OR nurses are on the med-surg units to maintain competency there, who's staffing the OR?

RichlyBlaq, ASN

Specializes in ICU, CCU.

3 minutes ago, Rose_Queen said:

But then that brings up issues of competency and the requirement to ensure that adequate time to maintain competency in all units. There’s the saying jack of all trades, master of none. In non-crisis times, would we be doing the right thing for quality patient care by requiring nurses to work in multiple specialties and having to change up skills constantly? Sure, some specialties are similar, but when you’re taking OR nurses and throwing them into med-surg, it’s a whole other world. And when those OR nurses are on the med-surg units to maintain competency there, who's staffing the OR?

Well you aren't training them to be full-time ICU nurses and be able to deal with bents or CRRT machines but you can train them to at least be able to titrate ICU drips and other basics so that they would provide adequate help when needed. I'm not trying to completely take away nurses from other units to be in ICU

^ Again, there is still the issue @Rose_Queen and others have mentioned. It sounds really good to say people should "at least" be able to titrate a bunch of critical drips, but that only becomes a basic skill when you do it frequently. These and more would still be considered low-frequency/high risk skills for nurses from other areas. People who work in higher-intensity areas take for granted a lot of the basic stuff they have learned. For example, many nurses on general floors might only rarely have the benefit of seeing a patient's cardiac rhythm in real time; rather, their patients may be on tele that is only viewed and monitored by someone else remotely.

It's easy to say in retrospect that a burden could have been eased if only nurses from other areas knew how to do the job done in a completely different area. In reality it would take a lot of commitment on the employer's part and would require nurses who do not appreciate the intensity of the ICU (for whatever reason) to nevertheless do it regularly in order to achieve and maintain competency.

The buddy-nurse concept seems the most viable (to me) but again, it usually isn't pre-planned and the assisting nurses aren't afforded basic training in order to fill in any gaps they may have. And since it causes the money people to wring their hands about two nurses to do one job, people are easily abused. A safer thing would be for there to be a pre-determined skill set for the guest nurses to have and maintain so that they can competently assist a primary RN in the other specialty.

simba and mufasa

Has 17 years experience.

Hi everyone

Thanks for taking the time to read my article. I totally agree with you that ICU nurses take for granted what they have learned and you also spoke about the buddy system. I gave an example of myself, am going to different units bcoz I get bored doing the same tasks on the same unit. It increases my knowledge and flexibility . However, If cross training is done on a voluntary basis, very few would sign up. To maintain skills, one month rotations are encouraged to maintain competency. This is like being stuck between a rock and a hard place, you are doomed if you don't and doomed if you do, I agree, administrators and managers can abuse nurses as they wish I,e moving or floating regularly.

Thank you

OUxPhys, BSN, RN

Specializes in Cardiology. Has 4 years experience.

I'm a PCU nurse. My background has been primarily cardiology. I'd have no problem learning to work in the SICU or the MICU/CICU but since I have zero experience working in an ICU setting I would only do it if I got an orientation similar to someone getting hired as a new grad. If not then forget it.

Recently my floor has been converted to the covid-19 floor and up until recently we had no patients so we were hanging out in MICU. Believe me, the MICU took full advantage (and not in a good way).

clamchopz, ASN

Specializes in New Grad- Emergency Room.

Everyone who have replied to this post have very valid points. Thank you for writing this article, and thank everyone on their input. As a new nurse, I find it very intriguing and I am more than willing to learn everything. I think new nurses need to be efficient where they are before they get crossed-trained. Or, begin to be cross-trained to a unit similar to their "home unit" before spreading their wings further. I would absolutely love to be that nurse who is the "jack of all trades." In reality, I can only learn so much at a time, and it would take me a while to get there. I'm still trying to find a job to begin with! Would my fellow new grads agree?

simba and mufasa

Has 17 years experience.

Thanks for taking the time to read my article. I totally agree that you should be comfortable in your home base then spread your wings.However, knowledge is power, the world of nursing is changing, COVID-19 proved it. We cannot keep doing things the old way, be empowered, protect your licence, don't be caught unaware, learn more, it is easier to learn when young???

tx

Munya