by Lauren Rewers, Senior Research Analyst and Allyson Paiewonsky, Research Analyst
Advisory Board's Lauren Rewers and Allyson Paiewonsky recently spoke with Julie Miller BSN, RN, CCRN-K, Clinical Practice Specialist, Devin Bowers MSN, RN, NE-BC, Practice Excellence Director, and Brad Johnson, Strategist from the American Association of Critical-Care Nurses (AACN) to learn how nurse leaders can prepare their staff to care for Covid-19 patients.
Q: Most projections show that the peak surge will be in about two weeks for many states. What should nurse leaders start doing today to prepare?
AACN: For organizations that are one or two weeks away from a surge, there are four considerations you should start thinking about now.
First, your PPE supply. Consider what your volume looks like, initiate feasible actions to procure additional PPE, develop a plan is to preserve your stock, and proactively communicate your plan to frontline staff.
Second, staffing. Create a plan to care for an increased volume of critical care patients. You should consider what units they will go to and which staff you will deploy. In addition, make sure you consider the skill mix of staff. You may need to use your experienced critical care nurses to help prepare and orient other RNs.
Third, training. You should consider what “mandatory trainings” you can stop doing now to free up capacity. Some hospitals are suspending orientations, moving to online and self-study, and stopping classes such as preceptor training. However, some of these trainings may be needed for cross training purposes, so each hospital needs to identify for themselves what will work best.
Lastly, moral distress. Hospitals must identify and provide resources to mitigate the harmful effects of moral distress on staff. We’ve published a position statement asking hospitals to begin thinking about this and how to support colleagues now.
Q: What kind of educational supports should nurse leaders have in place to prepare and cross-train their frontline?
AACN: Many nurses are overwhelmed by the information and skills they need to learn to care for patients with Covid-19. Nurse leaders need to focus their efforts only on the upmost important skills that the frontline will need.
For example, we’ve received lots of questions about ventilator trainings and skillset nurses need for ICU. To proactively address these concerns, we released our Covid-19 Pulmonary, ARDS and Ventilator Resources. This online course is free to help support nurses who need to be trained to care for patients with Covid-19. Additionally, with the ANA we’re co-hosting a webinar to address ventilator care. This webinar will be available later in the week on both organization’s websites.
We’ve also made pocket cards and a number of other key resources easily available on our Covid-19 webpage. Our pocket cards are a great quick reference for nurses working in an unfamiliar environment.
- Pulmonary Management Pocket Reference Card
- Commonly Used IV Cardiac Medications for Adults Pocket Reference Card
- Cardiovascular Assessment Pocket Reference Card
- Dysrhythmia Recognition Pocket Reference Card
- Hemodynamic Management Pocket Reference Card
Q: PPE shortages are top-of-mind for many organizations. What are you hearing from AACN members about preserving PPE?
AACN: We’re doing what we can to advocate and ensure all nurses have adequate PPE available to them. But nurse leaders need to think about what their plan B is if they don’t have the proper PPE available at their organization.
We heard that one organization is using OR nurses to observe other nurses as they don and remove PPE to make sure they’re doing it correctly and to observe for breaches. This helps prevent inadvertent exposures. Other organizations are getting creative and figuring out what can be done outside the room, for tasks such as IV infusion therapy and ventilator changes. Moving IV pumps and ventilator display consoles outside the room is innovative. This limits the frequency that nurses have to enter a room and helps preserve PPE.
Q: You mentioned that organizations need to expand the critical care staffing pool. Where should nurse leaders draw staff from to expand critical care capacity within their organization?
AACN: Pull those who are the closest fit to an ICU nurse, like nurses who work in post-anesthesia care. Many of them are former ICU nurses and know how to care for ICU patients. They are familiar with sedation, ventilators, and suctioning. These nurses already have some of the skillset needed to transition quickly. Some hospitals are using med-surg nurses in the ICU to help with nursing tasks and skills. These nurses have foundational skills that all patients need and can help supplement the staff in the ICU.
Children’s hospitals haven’t experienced surges so collaborative partnership may be helpful to expand capacity with staff, beds, or equipment. Some examples for consideration may include expanding admission criteria at the children’s hospital to accept older patients, or leverage pediatric ICU nurses’ higher acuity skills to help with staffing and cross training of other nurses. Some children’s hospitals have also loaned their ventilator equipment to adult centers in need.
You should also consider how you organize critical care teams. Many organizations are using a team-based approach to staffing. These teams consist of ICU nurses supported by nurses from other units. This structured team approach allows nurse leaders to delineate what each nurse is responsible for based on their skills. For example, the ICU nurse should take on the more advanced tasks and a med-surg nurse can complete tasks like initial assessments and medication delivery.
Q: What are the creative ways you have seen organizations create or repurpose critical care beds?
AACN: Hospitals are using progressive care units to expand capacity. They’re taking higher acuity patients that would normally be in an ICU, but that don’t necessarily have the critical respiratory distress of a patient with Covid -19, and moving them into a more progressive care unit.
We know most hospitals are attempting to cohort patients with positive and suspected Covid-19. One hospital plans to turn their neuro-ICU into a Covid-19 unit. When that happens, all neuro-ICU patients will be put on the open heart recovery unit, and the open heart recovery unit nurses will learn how to care for neuro-ICU patients. Creativity, flexibility and innovation in the face of this crisis is essential to managing the influx of patients.