Rapid Critical Care Training of Nurses in the Surge Response to the Coronavirus Pandemic

Diana Brickman, BSN, RN, CCRN-K; Andrew Greenway, MSN, RN, CCRN, AGCNS-BC; Kathryn Sobocinski, BSN, RN, CCRN, TCRN; Hanh Thai, MSN, RN, AGACNP-BC, CCRN; Ashley Turick, BSN, RN, CCRN; Kevin Xuereb, MSN, MSEd, RN, ACCNS-AG, CCRN; Danielle Zambardino, BSN, RN, CCRN, TCRN; Philip S. Barie, MD, MBA, Master CCM; Susan I. Liu, BSN, RN, CCRN, TCRN

Disclosures

Am J Crit Care. 2020;29(5):e104-e107. 

In This Article

Abstract and Introduction

Abstract

Background: In response to the coronavirus pandemic, New York State mandated that all hospitals double the capacity of their adult intensive care units In this facility, resources were mobilized to increase from 104 to 283 beds.

Objective: To create and implement a 3-hour curriculum to prepare several hundred non–critical care staff nurses to manage critically ill patients with coronavirus disease 2019.

Methods: Critical care nursing leaders and staff developed and implemented a flexible critical care nursing curriculum tailored to the diverse experience, expertise, and learning needs of non–critical care nursing staff who were being redeployed to critical care units during the surge response to the pandemic. Curricular elements included respiratory failure and ventilator management, shock and hemodynamics, pharmacotherapy for critical illnesses, and renal replacement therapy. A skills station allowed hands-on practice with common critical care equipment.

Results: A total of 413 nurses completed training within 10 days. As of June 2020, 151 patients with coronavirus disease 2019 still required mechanical ventilation at our institution, and 7 of 10 temporary intensive care units remained operational. Thus most of the nurses who received this training continued to practice critical care. A unique feature of this curriculum was the tailored instruction, adapted to learners' needs, which improved the efficiency of content delivery.

Conclusions: Program evaluation is ongoing. As recovery and restoration proceed and normal operations resume, detailed feedback from program participants and patient care managers will help the institution maintain high operational readiness should a second wave of critically ill patients with coronavirus disease 2019 be admitted.

Introduction

Since the first confirmed case of coronavirus disease 2019 (COVID-19) in New York State, new cases have increased exponentially, particularly in New York City, where epidemiologists projected that the health care system would be overwhelmed. In response, New York State mandated that all hospitals double the bed capacity within their adult intensive care units (ICUs).

Our facility mobilized physical and human resources to increase capacity from 104 to 283 beds. Operating rooms, recovery areas, and medical/surgical units were transformed into ICUs within days.[1] With this expansion, we realized that a sudden, massive influx of critically ill patients would necessarily transform how we communicate and deliver critical care.[2] Here we describe the process by which we transformed available nursing resources in order to care for a high volume of patients with COVID-19. Other institutions can adapt this process when facing similar challenges.

As the institution mobilized, expanding nursing resources became a priority. To fulfill new ICU requirements, we needed almost double the 358 full-time-equivalent nurses in the standard table of organization to ensure that we could maintain nurse to patient ratios. Thus nurses who do not typically manage critical illnesses were redeployed to supplement ICU staffing.

Because providers acquire competency through experiential learning, nursing leaders tasked clinical program coordinators, nurse specialists, and ICU nurses to create and implement a condensed program comprising didactics and supervised bedside practice in order to prepare individuals to participate in critical care nursing practice.[3] In less than 24 hours, we developed a 3-hour curriculum that included cardiac, pulmonary, and renal pathophysiology; care paradigms; and therapies and procedures anticipated for use when managing patients with COVID-19. Here we describe the development and implementation of this educational intervention.

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