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They are the doctors and nurses who keep you alive when your heart stops beating and your breathing fails.
Intensive care units are the last bulwark in the fight against coronavirus. Those on the barricades are very worried about winter.
The capacity, even without the crown, is not good enough, according to the head of the department of specialists in intensive care nurses Paula Lykke of the Norwegian Nurses Association.
– We have a lack of capacity and we are not at the level of Sweden. They have several beds and we have a different geography that gives us other challenges. Today, many regular nurses with no specialization are employed in intensive care units, Lykke says.
– You will lose people
The big fear is that the barriers against coronavirus are breaking down in society, that people are getting tired of strict infection control measures and being careless with the meter and the sink.
– What will happen if we have a peak of infection?
– The same we have seen in other countries. Those who work in intensive care units are truly traumatized and many of them will never work again. 20 percent of intensive care nurses in Norway are over 60 years old, do not return after being part of a spike in infection, says Lykke, who has spoken to those who worked the worst shifts in Sweden this spring:
– Then you remain standing for four hours in a row in the sickest patients without being able to drink or go to the bathroom. The Swedish nurses said he was completely quiet in the break room. Nobody said anything. A psychologist and a priest were to be present. There was not enough equipment or personnel. They said it was like being in a war. Sweden has better capacity than us. It’s scary.
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The Auditor General’s Office raised the alarm last year. There are too few trained intensive care nurses than the expected numbers. To become an intensive care nurse, two years of relevant hospital experience are required, prior to earning a 90-credit postsecondary education or master’s degree.
– Ten years ago the intensive capacity was increased, it was after we found out about the swine flu. Increased capacity will be both a buffer in everyday life and a bulwark in times of crisis. Bent Høie hasn’t done his job here. It is important that this work begins now, so we are prepared for future pandemics, says Ingvild Kjerkol, Labor Party health policy spokesperson.
The work proposes a greater capacity
The Labor Party is now proposing in the Storting that capacity should be increased. It is necessary to train more specialists, it is necessary to have more beds for times of crisis.
– Høie must now, for once, listen to the professionals. They yelled about this even before the pandemic hit. We cannot accept that Høie ignores the clear warnings over and over again, says Kjerkol.
Health Minister Bent Høie (H) points out that there is a balance between insufficient and excess capacity.
– Norway’s intensive capacity is on par with that of other Nordic countries. Intensive beds consume a lot of resources, so in a normal situation we cannot have many empty beds, Høie writes in an email.
Rebellion against Erna
Høie notes that an internal training program for intensive care nurses has been started. Health trusts have also been tasked with being prepared to be able to rapidly increase the number of intensive care units.
– In the revised national budget for 2020, funds were allocated for, among other things, 200 study places for the continuing education of nurses. This is in addition to existing study sites, Høie writes.
Regional differences
Intensive care physician Eirik Alnes Buanes is the head of the Norwegian pandemic registry. In a report last year, the registry pointed to the challenges Norway faces as a sprawling country with scattered settlements.
– I think it is true, as Høie says, that capacity in Norway is not that far from the other Nordic countries. What we saw in the intensive regional study last year was that there are regional differences. It will be important in the future that the capacity is sufficient throughout the country. Setting a goal about the capacity that one should have in each region is something that may be relevant to consider, says Buanes.
Kjerkol believes that Høie’s description is incorrect.
– Høie’s description is in stark contrast to last year’s intensive regional study analysis and strong warnings from professionals. Saving today on emergency preparedness, as the Minister of Health continues to do, could generate a much higher bill the next time a pandemic hits us. There is work to be done here to build a larger buffer, so we’re prepared when this happens again, says Kjerkol.
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– Balances on a line
Internal training means that nurses who do not normally work in intensive care can come in and contribute in an emergency situation. But then they depend on the support of both doctors and nurses with specialized training, says Buanes.
Paula Lykke cautions against believing that it will be a perfect solution with nurses who have received a two-week course when the training usually lasts two years.
– You don’t become an intensive care nurse in such a short time. If you ask nurses to do a job for which they are not competent, there is a danger. First of all for the patient, it is clear that he will do something with survival. But it is also very difficult for the nurse who finds herself in such a situation after receiving a two-week course. So we have to prioritize more, says Lykke.
Buanes shares the fears of Paula Lykke and the intensive care nurses. There is a vulnerability in the system in the sense that key people must be working. Not only in smaller places, but also in the largest hospitals.
– What we fear is ending up in a situation where intensive capacity is not enough. We balance ourselves on a line where little is needed to unbalance us, and we must be careful about the priorities that lie ahead, says Buanes.
In a dark winter
Must find space
Already today, doctors have to juggle to find space and staff for the sickest patients.
– Today, intensive care doctors spend a lot of time moving around patients so that you can find a monitoring space for those in need in the hospital. It says something about the fact that in some parts of the country the capacity is too small. It depends on both the beds and the staffing, continues Buanes.
Both Buanes and Lykke have an urgent prayer for those who are beginning to tire of infection control measures.
– We are lucky in Norway to have the infection under control, but I’m afraid that we will start to give a damn about infection control and that we think we are doing well. Yes, most people don’t get so sick they end up in the intensive care unit, but no one knows if it’s you or me who will come in and fight for life, says Lykke.
– I think Høie does a very good job as Minister of Health. It is clear and I know that he sees the same thing as me and I am worried. Otherwise, it would not have closed the country on March 12, he concludes.
