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The redeployment of non-critical care nurses into overwhelming critical care roles is putting pressure on intensive care units as hospitals run out of options amid rising Covid-19 admissions.
It occurs when hospitals across the country reach their responsiveness by converting operating rooms and resuscitation areas into intensive care areas to accommodate patients in critical care..
At St James Hospital in Dublin, where 18 Covid-19 patients were receiving intensive care treatment, the demand for critical care nursing is currently outstripping supply, leading to the reassignment of staff from other disciplines to the highly specialized critical care area.
“Ultimately, there are fewer staff available for a greater amount of work,” said Dr Enda O’Connor, director of the ICU at St James Hospital, Dublin.
“An intensive care nurse is a very specialized staff member and you cannot just pull an intensive care nurse out of the ether.
“What we have to do is reassign staff from the non-intensive care parts of the hospital to work in intensive care. We are very grateful and delighted to have this staff and I want to be clear about it.
“They receive training in the core aspects of caring for critically ill patients. But these are people who work outside of their comfort zones. Much of these staff are specialists, but in a different area. But that’s what we have to do, we have to do the best we can, “he added.
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Training: HSE Intensive Care Clinical Leader Michael Power. Photo: Colin Keegan, Collins Dublin
Colin keegan
At Mater Hospital, Dublin, nurses who trained in intensive care until a decade ago and then moved on to other specialties are being “retired” to face the crisis.
The hospital, which has activated its emergency plan by caring for some of its critically ill patients in the high dependency unit, is currently facing significant staff problems.
Serena O’Brien, director of clinical nursing in intensive care at the hospital, said the prospect of staffing an ICU with “emergency nurses”: nurses reassigned from other areas of the hospital – it was disheartening.
She said: “When we talk about increasing staffing, we are bringing intensive care nurses who have no intensive care experience and I can’t begin to tell them how scary it is (for them).”
Ms O’Brien, who is also President of the Irish Association of Critical Care Nurses, acknowledged that some nurses across the country, who received limited training after the first surge, will be immersed in daunting intensive care environments due to to the third wave of Covid -19.
It is understood that staff in the smallest hospitals across the country have already been reassigned to intensive care nursing duties.
“Critical care nursing is a highly skilled profession,” he said.
“He is asking a nurse to come and take care of a ventilator. They have never seen one. They have no idea. They wouldn’t even know where the on / off button is. How would they do it? They have a different skill set in the neighborhood.
“We ask them to enter a completely different environment that is much more high-tech.
“Then we will also throw a dialysis machine on them, then we will put PPE on them for 12 hours and tell them they can’t leave the room. If they are struggling, they have to greet someone walking past for help. This is scary.”
Emphasizing the complexities of the critical care nursing role, Ms O’Brien noted that the staff undergo years of intensive education and training and that caring for an ICU patient requires individualized expertise 24 hours a day, 7 days a week.
“A ventilator needs to be cared for and monitored 24 hours a day, 7 days a week,” he said.
“There are parameters in that machine specially configured for each patient and their lung condition at that time. We record those values every hour. That is just to support your lungs. They may also be taking blood pressure or dialysis medications because their kidneys often fail, particularly with Covid.
“That’s why you need a nurse, 24 hours a day, 7 days a week, because it is not just about taking care of the patient, there are a multitude of devices that surround the patient and support all their organs 24 hours of the day”.
On Monday, Dr. Michael Power, HSE Clinical Leader for Intensive Care, said 1,300 nurses have received critical care training since last April and are now being identified so they can be approached and reassigned.
Meanwhile, at St James’s, the administration began surge plans last week, according to Dr. O’Connor.
“It’s a phased process,” he said. “A tiered plan, generally with five or six phases, depending on the hospital.
“We are actively planning for the later stages. What that means is that intensive care is expanding into parts of the hospital right now that are not really, traditionally, intensive care areas at all.”
Dr O’Connor said this involved reconfiguring areas like operating rooms, which are not in use due to canceled elective procedures, into areas that can accommodate Covid patients, including critically ill patients on ventilators.
“He’s basically turning the wards into temporary intensive care areas,” he said.
“They are temporary, they are not as good as the proper intensive care beds, for the simple reason that intensive care beds are strategically designed and designed specifically for the management of critically ill patients. We are doing the best we can with the limited infrastructure we have.
“We have all the vital equipment that we need right now, things like ventilators and dialysis machines. The infrastructure is there, but it is not optimal, there is no question about that. The equipment is there, but staffing is our biggest problem. “.
With a battered workforce that has already endured nearly a year in the front-line battle against Covid-19, there is concern about the impact of sending inexperienced staff to intensive care settings.
“We have conducted a survey here at the local level and there was a high level of stress and anxiety for these nurses who were emergency nurses during the first wave,” Ms. O’Brien said.
“With that said, we provided them with some basic education to help them get ahead. We have ongoing augmentation training, which takes place in all ICUs across the country.
“They are getting a certain level of education, they can do something else online and we do a bit of bedside training and then we support them when they are here.
“Good standard critical care is an intensive care nurse standing at your bedside 24 hours a day, 7 days a week. We cannot achieve that in a pandemic during a surge. And that’s the fear as nurses, we want to make sure that all of our patients receive our care. “
Catherine Motherway, director of the ICU at Mid-Western University Regional Hospital in Limerick, cautioned that hospitals here are currently three weeks behind London.
“It’s potentially very bleak,” he said.
“I think people need to see what is happening in London because we are about three weeks behind, but we can stop this. The only people who can stop this are the public. All we (the health staff) can do is respond. “
Dr. Motherway said that the prospect of having a physical ICU bed with no staff to care for it was “terrible.”
“We haven’t arrived yet,” he said. “It’s a potential, very scary possibility.”
Dr Alan Gaffney, who works in the ICU at Beaumont Hospital and is the Vice President of the Intensive Care Society of Ireland (ICSI), told RTÉ’s Morning Ireland that hospitals are moving towards their scaling capacity, with 285 patients in the ICU last night.
He said hospitals are now working to address staff shortages.
“The kind of problems that we had in March and April, which were problems with equipment and PPE, are not the problems that we have now. Now, we are in a situation where we are following the plans that we have put in place to allow us to increase But that course requires staff at the moment and staffing becomes our biggest problem, “he said.
He said staff is being “snooty” and some nurses are reassigned to the ICU from other sections of the hospital.
Dr. Gaffney said that patients in the ICU require a lot of physical care, staff should contact families to update them on their conditions, and PPE should be worn throughout their shifts.
“At the end of the day, we have a very hard-working and professional staff.
“Anyone who comes to the hospital and who needs ICU will be treated by us in the hospitals,” he added.
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