Jump to content

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

Updated | Published

Has 17 years experience.

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. You are reading page 3 of Massive Shortage of ICU Trained Nurses During COVID-19 Pandemic: The Need for Cross Training. If you want to start from the beginning Go to First Page.

I think instead of furloughing nurses, hospitals should be training them in the ICU or critical care units via a residency program. That way they're getting skills training yet are already employed and getting paid. Win-win for employees, the facilities, and patients during emergency situations.

simba and mufasa

Has 17 years experience.

1 minute ago, NurseBlaq said:

I think instead of furloughing nurses, hospitals should be training them in the ICU or critical care units via a residency program. That way they're getting skills training yet are already employed and getting paid. Win-win for employees, the facilities, and patients during emergency situations.

I totally agree with you, train nurses instead of hiring travel nurses and paying them 3 times more than your regular staff. If nurses keep up their skills in the critical care area, it is a win win for the patients, hospital and job security for nurses. I hope the pandemic has taught us a learn, be prepared !

Tx

Dr Madenya

4 hours ago, munyaradzi rwakonda said:

I totally agree with you, train nurses instead of hiring travel nurses and paying them 3 times more than your regular staff. If nurses keep up their skills in the critical care area, it is a win win for the patients, hospital and job security for nurses. I hope the pandemic has taught us a learn, be prepared !

Tx

Dr Madenya

Indeed. I get having travel nurses during an uptick in the pandemic, but use them too to train your staff nurses. Then when as they get better, you won't need the travel nurses any longer unless you are short staffed.

CCU BSN RN

Specializes in CICU, Telemetry. Has 7 years experience.

Things like 'Team Nursing' would work so much better if I'd ever met the members of my 'Team' before I was expected to work on a team with them and appropriately delegate patient care tasks to them while also managing a criminally unsafe ICU assignment with 3-4 intubated, proned, paralyzed patients on multiple pressors. Because I barely had time to ask what unit they came from before I was being pulled in several directions to put out dumpster fires in every single room. If they were given ANY training about where supplies/meds were kept, titrating ICU drips, or if we were able to spend half an hour together so I could in-service them before assuming care of anybody...I could make it work infinitely better. Unfortunately, at least at my institution, there were 2 separate entities: the administrators writing endless policy upgrades on zoom meetings at home, and the nurses trying not to feel like they committed a murder secondary to criminally unsafe staffing. These 2 entities had no contact with one another, and thus no administrators were willing to acknowledge or change policies/procedures based upon how poorly the rollout was going.

herring_RN, ASN, BSN

Specializes in Critical care, tele, Medical-Surgical. Has 49 years experience.

No one should have to suffer what you, your coworkers, patients, families, and physicians are going through.

I'm only offering ideas. I pray that your hospital stops their criminal unsafe staffing and tries to do the right thing for patients and staff. It may not be possible for you and other nurses to inform the public, who may need care at your hospital, of how dangerous it is. Please ignore anything that is not feasible in your situation. Sometimes all we can do it pray.

We learned that the scientific method used by nurses as The Nursing Process. Assessment, including data collection. Regarding your hospital IF possible you can keep a diary of your assignment minus patient identification OR fill out an SDO. I attached two ADOs. The one not by a union is best, but both model language that may be helpful.

I found a COVID-19 specific Assignment Despite Objection (ADA). I gives a format for documenting conditions. If possible inform someone who can act to improve the unsafe conditions.

From the ADO: I/we hereby protest my/our work assignments because:

  • Unsafe nurse/patient ratio contributes to unsafe patient care and spread of disease
  • Lack of N95 respirators
  • Not fit-tested
  • Not given same size/model originally fitted
  • Lack of impenetrable gowns
  • Lack of masks
  • Lack of face shield/eye protection
  • Lack of gloves
  • Lack of booties
  • Lack of PAPRs
  • Lack of ventilators
  • Lack of disinfectant supplies
  • Inadequate number of negative pressure rooms
  • Covid-19 patient(s) not properly isolated
  • Visitor policy not enforced
  • RN given assignment who is immunocompromised, pregnant, breastfeeding or 65 and older
  • Told not to use self-provided PPE
  • Failure to test patients meeting signs and symptoms

https://www.minurses.org/covidADO/?eType=EmailBlastContent&eId=675be001-4afb-432c-b0d8-0538c4d9baf2

Assignment_Despite_Objection_Form.pdf

ADO_a9f823a8e604abb607_fym6b9n3r.pdf

scribblz, BSN, CNA, LPN

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

1 hour ago, CCU BSN RN said:

Things like 'Team Nursing' would work so much better if I'd ever met the members of my 'Team' before I was expected to work on a team with them and appropriately delegate patient care tasks to them while also managing a criminally unsafe ICU assignment with 3-4 intubated, proned, paralyzed patients on multiple pressors. Because I barely had time to ask what unit they came from before I was being pulled in several directions to put out dumpster fires in every single room. If they were given ANY training about where supplies/meds were kept, titrating ICU drips, or if we were able to spend half an hour together so I could in-service them before assuming care of anybody...I could make it work infinitely better. Unfortunately, at least at my institution, there were 2 separate entities: the administrators writing endless policy upgrades on zoom meetings at home, and the nurses trying not to feel like they committed a murder secondary to criminally unsafe staffing. These 2 entities had no contact with one another, and thus no administrators were willing to acknowledge or change policies/procedures based upon how poorly the rollout was going.

That sounds horrific. Is your unit manager out of touch with your reality that they allowed this to happen?

I can't imagine cross training to the ICU. That type of nursing is an art just as much as a science. It takes years to become competent. How about we hire and train an appropriate number of staff before a pandemic hits?

On 7/2/2020 at 2:35 PM, scribblz said:

That sounds horrific. Is your unit manager out of touch with your reality that they allowed this to happen?

This is most likely the norm rather than the exception.

simba and mufasa

Has 17 years experience.

Its better just to have the foundation. Those cross-trained nurses can be rotated to the ICU at least for a week monthly to keep and improve skills, eventually becming competent.

simba

NickICU-RN, ADN, BSN

Specializes in ICU. Has 20 years experience.

Important and great article to share, Thank you... whether or not hospitals will take it seriously and do train additional staff correctly is the next question???

Deborah Cohen, BSN, RN, CNM

Specializes in Critical CarE, WOCN, DELEGATION, CASE MANAGEMENT,. Has 39 years experience.

I agree that cross training is a good idea and it should be done as part of an orientation. I have a BSN but never did a rotation in critical care. The level of understanding of pathophysiology and drug Chemistry is essential in these units as well as critical thinking skills and the ability to react quickly in rapidly changing situations. It's not for everyone. During orientation each nurse should be evaluated for these skills. It's unfortunate that Covid has created a situation that has put first responder nurses in unfamiliar situations forced to learn with boots on the ground. I hope educators and administrators have learned a lesson from this horrible Pandemic.

simba and mufasa

Has 17 years experience.

Hie Deborah

I agree ICU is not for everyone, but as proven by the pandemic, gears can shift quickly and all of a sudden you find yourself working in ICU. This is a time to be proactive instead of being reactive. Prepare, you might never know what's coming tomorrow. Act now or you will be in this predicament again.

simba and mufasa

Wizard 1

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc. Has 12 years experience.

I am 50/50 on cross training. I think it depends on how it is done. Putting an OR nurse in a bedside nursing situation, when that is not the nature of what they do on a daily basis, doesn't seem like it is a good idea, and the same for taking Labor/Delivery/Postpartum nurses and putting them in an area outside their skill set. Perhaps having nurses that already work with critically ill patients on other units go to ICU would work better, because it is similar to what they do. Covid-19 patients that are sick enough to be in the ICU require not only a lot of care, but also specialized assessment skills. Having nurses from areas that don't use a similar skill set required to care for patients that challenge even seasoned ICU nurses is a recipe for disaster.

Additionally, how to maintain competencies? Unless one is a Float nurse that does work in different areas often enough to be able to do this, I'd think it would be difficult.

Lastly, becoming skilled enough in caring for critically ill patients if one doesn't work with them in their specialty requires structured orientation. One doesn't just throw nurses out there and hope they'll swim and not sink. Nurses are not interchangeable.