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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 4 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.

Deborah Cohen, BSN, RN, CNM

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

I wholeheartedly agree with Wizard 1. As I stated in a previous comment, Nursing schools need to address evolving health crises and adjust the curriculum accordingly. There needs to be emphasis placed on critical thinking skills. Rotations in Intensive Care need to be added and other specialty rotations should be deferred. Hospital orientation should include Intensive Care training just as a resident physician. It's time to step it up a notch.

OUxPhys, BSN, RN

Specializes in Cardiology. Has 6 years experience.

2 hours ago, Deborah Cohen said:

I wholeheartedly agree with Wizard 1. As I stated in a previous comment, Nursing schools need to address evolving health crises and adjust the curriculum accordingly. There needs to be emphasis placed on critical thinking skills. Rotations in Intensive Care need to be added and other specialty rotations should be deferred. Hospital orientation should include Intensive Care training just as a resident physician. It's time to step it up a notch.

This. THIS. I got blasted in an older post because I said the old guard still runs things how it was when they were floor nurses and hasn't conformed to the new way things are done. OB and peds should not be a required rotation. It is a specialty. Students should have the option pick what specialties they are interested in for the remainder of their clinical hours. They have to accept that new grads can start anywhere now. You do not have to go to a med/surg floor first.

simba and mufasa

Has 17 years experience.

OUxPhys, BSN, RN

I totally agree, in OB and mother baby, we do not have hands on at all. Students just observe and waste time doing paperwork. ICU rotations will give students opportunity to learn and familiarize with the environment. It's time to change and move with the times.

simba and mufasa

simba and mufasa

Has 17 years experience.

Wizard 1

I would rather be armed with knowledge than be thrown to the wolves. So far my hospital has initiated the ICU cross training, and for competency, nurses are rotated once a month to the ICU and many are liking it.

simba and mufasa

noemer

Specializes in Med/Surg, Trauma, Telemetry, Step Down, PCU. Has 11 years experience.

I attempted to cross train to the ICU at my old job at a 550 bed trauma center. Over 3 years working Surgical/Trauma/Telemetry with some of the most complex SICU patients, 10 years as a nurse total. I was told from HR that "it says you don't have enough experience." They just hired 14 new grads for their ICU. Why don't they just say ADN's don't count since we are a Magnet Hospital. Remember this was an internal transfer.

barcode120x, ADN, BSN, RN

Specializes in Telemetry. Has 6 years experience.

My coworker and I were the first telemetry nurses in the hospital to take covid/critical care patients. One on two drips, the other on one. Both fairly stable for the most part overall. We had a critical care nurse that picked up 8 hour extra shift to "oversee" us and our drips. Thankful to have her and she took charge of the drips and charting and helped us out anyway she could.

Overall, it was an OK experience (except with my frequent head turns to check how my septic patient's BP was). Not going to lie, but it was a good shift of "team nursing" (that's what our hospital is calling it if we have to break ratios or cross over specialties in light covid).

Would I do it again? Hell no, as much as my night was OK and I definitely know I could manage it IF it happened again, I don't want that liability if something does happen. I am nowhere near interested in CC nursing.

If I have to do it, will I? Unfortunately yes and I may have no choice as it seems like they are pulling the seasoned nurses first to take these patients.

And, we had 0 "cross training." I literally walked into the shift last night not knowing this was gonna happen.

simba and mufasa

Has 17 years experience.

noemer and barcode

noemer, you should have grieved the hiring. You should have been given first preference since you are in house. Unbelievable that they have to hire new grads.

barcode

We also did team nursing. PAs and NPs who could not take patients were ancillary staff, pulling meds from pyxis, talking to family and helping with turning and repositioning and all the craziness that came with COVID-19. Even as a seasoned ICU nurse, I was emotionally and physically burdened. I hope this was the first and last round because I am not doing it again.

tx

simba and mufasa

9kidsmomRN

Specializes in Cardiac. Has 30 years experience.

Our hospital “upskilled” nurses to meet the anticipated surge in ICU patients related to COVID, but 2 classes and one 12 hour shift shadowing an ICU nurse does not an ICU nurse make. I don’t think less of the nurses who float to my unit, but I also realize that they don’t think the way that an experienced ICU nurse thinks. I would love to work with a med surg nurse with a good work ethic who is as concerned about my patients’ outcomes as I am. Together we can care for a team of patients and get the job done—me focusing on the critical care aspects and titrations etc. as long as my co-nurse pitches in with the cares, helps with turns, skin care, suctioning, I/O, using his/her assessment skills to alert me of impending problems and the many other essentials to have a good pt outcome.

My worry is if we “cross train” every nurse to every unit is that we then end up with a huge “float pool”, with no one being a specialist. This is dangerous! Imagine a time or place where you show up for work and 12 RNs are sent to work an ICU, 15 are sent to work tele, Etc. An environment like that would be flippin’ scary. As much as some units have political/social issues, at least you know what to expect and who you can count on... float pool certainly has a place, but we all can’t expect to perform at our best if we aren’t in a particular environment consistently. Going to a unit once a month or worse once every 6 months does not keep you competent on that unit with the ever changing technologies and protocols. There have to be experienced core staff who can field questions. I’m not saying that this staff sharing situation could happen, it’s just the daymare that I envisioned as I read the article and some of the comments. It is not a world that I would work in.

On 7/20/2020 at 5:27 AM, Deborah Cohen said:

There needs to be emphasis placed on critical thinking skills.

They fancy themselves as doing that; it's supposedly what the NCLEX is all about "now" and all of that...

What schools need to focus on is clinical freaking nursing care. From the sounds of it, clinical experiences have gone to h*ell. I don't know exactly why, sounds like a bunch of different reasons. Nurses believing that a "monkey" can learn how to start an IV or take a blood pressure, BSNs being taught that there are better/higher/blah blah roles for them since they are "professional nurses" -- spending tons of time learning about process improvements and change managements and stuff that is worth about a 1-day overview. Then they bring these people to an actual clinical site and pass them off on the staff nurse who doesn't have time for it. Meanwhile, the hospitals want to hire BSNs to care for patients at the bedside. Well....somebody has to get everyone's sleeves pushed back up and teach them how to do it. And to incorporate critical thinking while doing it, yes.

Hospitals are no help, BTW, with all of their "liability concerns," game-playing and restrictions they put on schools and student nurses. They have become control freaks that are really becoming enemies of this profession IMO.

On 7/20/2020 at 11:33 AM, simba and mufasa said:

I totally agree, in OB and mother baby, we do not have hands on at all. Students just observe and waste time doing paperwork.

That's unfortunate; I'm not sure it proves anything other than the inappropriate training of students; not letting them do things they should be doing. I've been pretty pleased with my student experiences in OB/peds/mother-baby as an ED nurse. 🤨

What is needed IMHO is what has always been needed: Learning and knowing the book stuff, excellent hands-on experiences (not simulations), and the incorporation of critical thinking. Lots of things change, but not this as far as I'm concerned. It has nothing to do with old guard/new guard.

To add to what @JKL33 said, clinicals should correlate with class lectures. For example, we did psych rotations while during psych that semester. I've heard of people doing clinicals wherever they can get in, like psych rotation during med surg lecture. I don't know how true that is because it's been a while but I've heard horror stories that would have never made the cut during my days.

Lordy, I sound like the old folks in my family with that "back in my days...", excuse me y'all. I'm going to go elsewhere now. 😂

ladycody, BSN, RN

Specializes in CWON. Has 9 years experience.

Just gonna throw out that not everyone wants to do the care being discussed....and just because the program for licensing requires clinicals doesn't mean that bedside pt care can be mandated to one and all. Statistics is mandated for all...but it doesn't mean I HAVE to agree to a numbers gig. This kind of thing is true on all levels. You can't take an elementary teacher and say you need to teach college or vise versa...nor would people think it's reasonable. Yes...for those willing...it should be provided...a FULL training process...but the expectations I've seen for nurses to adapt in our current environment just because It suits others are often unreasonable. jmo