Using Med Surg nurses in the ICU covid unit

[KellyRN86, BSN, RN]

Hi,

I work in a MICU and as of Wednesday we will be the official ICU for covid patients. There are several other lower acuity floors for covid but if they need to be intubated, etc they will come to us. Any of our normal "clean" MICU patients will overflow to PACU which they have set up as a makeshift ICU staffed with a combo of PACU and ICU nurses from other ICUs. As of Wednesday our unit is also starting to use med surg nurses to "help give us a break" but really it is to stretch the ICU staff when ICU patients overflow elsewhere. What it looks like is this: 4 ICU patients to 1 ICU nurse, and 2 med surg nurses, and that is the team. They are saying the med surg nurses are taking care of the patients and we are doing all the ICU related stuff that they can't do (which, these pts are extremely sick...proned/vented/A lines/drips etc, so that's a lot of stuff for 4 pts). I'm trying to stay positive about it, but they are essentially taking us from 12 ICU nurses for a 23 bed unit to 6 ICU nurses and 12 med surg nurses. My question is, is anyone else having to do this? What are some barriers you've run into, what are some good things, and what are the legal ramifications? They are saying it's "not on our license".... But the med surg nurses have been given a 4 hr crash course in basic ICU stuff, so they aren't technically competent and so how is it fair to them? And how is it fair for us if we have 4 vented patients? If anyone has input I would appreciate it.

[MunoRN, RN]

I haven't had any reason to complain about this arrangement. As you point out, you would be going from 12 to 18 nurses, and while these nurses can't do all of the 'ICU-level' stuff, most of what takes our time are things a floor nurse can do, these nurses are probably more capable in the ICU than you assume.

[Wuzzie]

I agree Muno. I actually think this is a brilliant way to expand a hospital’s ability to care for critically ill patients. Med-Surg nurses aren’t stupid. They will likely start picking up the “ICU level” stuff in a short period of time. No, they won’t be managing CRRT machines but their assessment skills will get honed, they’ll learn about managing pressors, skills like pulling ABGs, advanced VS monitoring. Plus they’re beasts at multi-tasking and managing multiple patients. It’s a win-win for everyone. Where I am they are likely going to pull ambulatory nurses (who have bedside experience) into the same role. Because of my background, even though it’s been a while, I’m first on the list to be pulled. I anticipate it to happen within the next 2 weeks.