The redeployment of non-intensive care nurses to complex ICU roles is placing an increasing strain on intensive care units as hospitals lack options amid increasing Covid-19 hospitalizations.
This is happening as hospitals across the country increase their capacity, converting surgical wards and intensive care units into intensive care areas to accommodate patients in need of intensive care.…
At St James’s Hospital in Dublin, where 18 patients with Covid-19 were in intensive care, the demand for nurses in intensive care units is currently outstripping supply, leading to a redeployment of staff from other disciplines to the highly specialized area of intensive care.
“Ultimately, fewer staff are left to increase workload,” said Dr. Enda O’Connor, director of the intensive care unit at St. James Hospital in Dublin.
“An intensive care nurse is a very specialized staff member and you can’t just magic an intensive care nurse from the air.
“What we need to do is redeploy staff from non-intensive care units in the hospital to work in intensive care units. We are very grateful and delighted to see these staff and I want to clarify this.
“They are being trained in the basic aspects of caring for critically ill patients. But these are people who work outside their comfort zone. Many of these employees are specialists, but in a different field. But this is what we must do, we must do everything in our power, ”he added.
At Mater Hospital in Dublin, nurses who went through intensive care until a decade ago and then moved on to other specialties are “recruited” to deal with the crisis.
The hospital, which has stepped up its emergency plan by caring for some of its critically ill patients in a highly addictive ward, is currently facing significant staffing challenges.
Serena O’Brien, Clinical Nurse, Intensive Care Unit Manager at the hospital, spoke about the prospect of staffing the ICU with “nurses” – nurses transferred from other parts of the hospital – was terrifying.
She said, “When we talk about the talent pool, we take nurses who have no experience of intensive care in intensive care, and I can’t tell you how scary (for them) it is.”
Ms O’Brien, who is also chair of the Irish Intensive Care Nurses Association, acknowledged that some nurses across the country who received limited training after the first surge will be immersed in a fearsome intensive care environment due to the third wave of coronavirus. -19.
It is understood that staff in small hospitals across the country have already been transferred to intensive care nurses.
“Nursing in intensive care is a highly skilled profession,” she said.
“You ask the nurse to come and look after the ventilator. They never saw one. They have no idea. They don’t even know where the on / off button is. How would they? They have a different skill set in the department.
“We ask them to move to a completely different environment, much more high-tech.
“Then we’re going to throw a dialysis machine at them, then we’re going to put them in PPE for 12 hours and tell them they can’t leave the room. If they struggle, they have to wave to someone for help. This is scary.”
Highlighting the complexity of the role of a nurse in ICUs, Ms O’Brien noted that staff go through years of intensive education and training and that caring for an ICU requires personalized 24/7 experience.
“The ventilator needs to be looked after and monitored 24 hours a day, 7 days a week,” she said.
“This machine has parameters customized specifically for each patient and the state of their lungs at the time. We record these values hourly. It’s just to support their lungs. They may also take blood pressure medications or dialysis because their kidneys often don’t work, especially with Covid.
“This is why you need one nurse working 24/7, because it’s not just patient care, but many devices surrounding the patient and supporting all of his organs around the clock.”
On Monday, Dr. Michael Power, clinical director of the HSE Intensive Care Unit, said that 1,300 nurses have completed intensive care since April last year and are now being identified so that they can be referred to and redeployed.
Meanwhile, in St. James last week, management initiated plans to increase production, according to Dr. O’Connor.
“This is a step-by-step process,” he said. “A step-by-step plan, usually in five or six steps, depending on the hospital.
“We are actively planning more advanced stages. This means that intensive care is expanding to parts of the hospital that are not really traditionally intensive care areas. “
Dr O’Connor said this required reconfiguring areas such as surgical wards, which are not in use due to canceled procedures, to areas that can receive Covid patients, including critically ill patients using ventilators.
“This essentially turns the wards into temporary intensive care units,” he said.
“They are temporary, they are not as good as normal intensive care beds, for the simple reason that intensive care beds are strategically important for the treatment of critically ill patients. We do our best with limited infrastructure.
“We have all the vital equipment we need at the moment, such as ventilators and dialysis machines. The infrastructure is there, but it is not optimal, there is no doubt about it. The equipment is there, but staffing is our biggest problem. “
With a battered workforce that has withstood nearly a year on the front lines of the battle with Covid-19, there are concerns about the consequences of sending inexperienced personnel to intensive care units.
“We did a local survey here and found high levels of stress and anxiety among these nurses who were nurses during the first wave,” said Ms O’Brien.
“However, we provide them with basic education to help them get through this training. We constantly conduct additional trainings, they are held in all intensive care units throughout the country.
“They get a certain level of education, they can do some other things on the Internet, and we do some training at the bedside and then support them when they are here.
“A good standard of critical care is a nurse who stands at the head of your bed around the clock. We cannot achieve this during a pandemic during a surge. And this is fear, as nurses, we want all of our patients to receive our help. “
Katherine Motherway, the head of the intensive care unit at Midwestern University Regional Hospital in Limerick, warned that hospitals here are currently three weeks behind London.
“It’s potentially very dark,” she said.
“I think people need to keep an eye on what’s going on in London because we’re about three weeks behind them, but we can stop that. The only people who can stop this are the audience. All we can do (medical staff) is react to it. “
Dr. Motherway said the ability to have a physical bed in the intensive care unit and the lack of attendants was “terrible.”
“We’re not there yet,” she said. “This is a potential opportunity, very dire.”
Dr. Alan Gaffney, who works in the intensive care unit at Beaumont Hospital and is the vice president of the Irish Intensive Care Society (ICSI), told RTÉ Morning Ireland that hospital capacity is increasing and 285 patients are in intensive care units last night …
He said hospitals are now working to address the shortage of staff.
“The problems that we had in March and April, namely the problems with equipment and PPE, are not the problems that we have now. We are now in a situation where we are following the plans we have developed to allow us to grow, but this course requires staff at the moment, and staffing is becoming our biggest challenge, ”he said.
He said that the staff was “stretched” and some nurses were being transferred to intensive care from other departments of the hospital.
Dr. Gaffney said that patients in the intensive care unit need a lot of physical care, staff need to communicate with families to inform them of their condition, and PPE needs to be worn throughout their shift.
“After all, we have a really hard working and professional staff.
“Everyone who comes to the hospital and everyone who needs an intensive care unit will be monitored in hospitals,” he added.