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

Discussion

Nurses trained through this program were deployed to established and temporary ICUs, where they were required to use the skills and knowledge they had obtained as they worked alongside experienced critical care nurses. At the peak of the surge, ICU capacity was expanded from 104 to 283 beds; this increase was made possible by creating and opening 10 operational temporary ICUs (including 1 postanesthesia care unit and the main operating suite). Six weeks into this process of training and redeployment, 151 patients with COVID-19 still required mechanical ventilation (72% of the patients who had required this during the peak of the surge). Most of the nurses trained under this program continue to practice critical care, either as independent practitioners or in supportive nursing roles, thus validating the effort that went into this training.

Because of the urgent and unpredictable nature of the spread of COVID-19 in New York City, the timeline for organizing and implementing this crucial program was highly compressed, limiting our opportunity to collaborate extensively with other content experts within the institution. The curriculum was based on the predicted needs of a critically ill patient with COVID-19, but we could not anticipate all clinical care needs and complications. For example, neither the widespread use of prone positioning to maintain ventilation-perfusion matching in patients with acute respiratory distress syndrome, nor the challenges of maintaining the patency of vascular catheters and dialysis circuits, was anticipated and thus neither was addressed.[4] Coverage of these topics would have been beneficial, but it also would have lengthened the curriculum, thereby limiting the number of courses we would have been able to offer.

Last-minute scheduling changes and attempts to accommodate participants' work schedules made collecting demographic data from every participant challenging, although contact information for all 413 participants is available for follow-up. Because patient care areas in the hospital were being constantly repurposed, and because of the need to maintain social distancing, we had to adapt our educational presentations to learning sites different from those we would normally use. Program clinician-educators were at high risk for acquiring COVID-19, and thus we made preparations for the potential long-term absences of preceptors; fortunately, none required a leave of absence for illness.

Our evaluation of the success of this program is ongoing. As the incidence of new infections continues to decrease and the day-to-day operations of the hospital return to normal, we plan to gather detailed feedback from program participants and the patient care managers who oversaw unit-level integration into critical care practice. Going forward, should we need to care for a second wave of critically ill patients with COVID-19, we will be able to maintain high operational readiness.

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