Post COVID-19: Will ICU Nursing Ever Be the Same?
By Debra Wood, RN, contributor
Critical-care nurses have remained on the front lines of caring for COVID-19 patients, often during challenges with equipment and staffing. How will ICU nursing change post-COVID-19?
“As a world, we have a new normal as all industries have been impacted, and nursing is no different,” said Megan Brunson, MSN, RN, CNL, CCRN-CSC, night shift supervisor in the cardiovascular ICU at Medical City Dallas Hospital and the 2019-2020 president of the American Association of Critical-Care Nurses (AACN).
“The pandemic has tested the capacity of our system, and now as states are opening back up, we are also seeing non-COVID patients needing significant amounts of care, as their healthcare needs were put on pause,” Brunson continued. “Collaboration, staffing, contingency planning and innovative ideas have been key and will continue into the future.”
Angela Chaney, RN, BSN, CN4, a critical care nurse at Mercy Medical Center in Baltimore, said she thinks working in the ICU “will be better, because everyone had to come together, and now our team is even stronger. … If we can get through this, we can get through anything.”
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Collaboration in ICU Nursing
Brunson reports collaboration and valuing each other’s contributions have reached all-time highs during the current crisis. ICU nurses are sharing solutions on social media, Zoom calls and blogs with nurses within health systems and across state lines.
“Going forward, we need to continue to put aside competition between systems by highlighting daily that putting the patient and healthcare providers first is essential,” Brunson said. “The pandemic has also presented an opportunity to forge strong partnerships between bedside caregivers and leaders, more than ever before.”
As surge staffing occurred and nurses from other departments stepped up to the ICU, nurses developed a better understanding of each other’s contributions and expertise.
They “have learned from each other,” Brunson said.
Front-line nurses who understand the minute-to-minute critical needs of patients are making the best decisions and innovations, Brunson said, adding that ICU nurses have approached barriers with solutions.
“Innovation is one of the positive things that has come from this pandemic,” Brunson said. “I am in awe at the creative, evidence-based solutions we are seeing that keep patients and healthcare teams safe.” She expects that ICU nursing after COVID-19 will include some of the discoveries and adaptations nurses came up with during the pandemic.
Brunson indicated nurses’ innovations have included:
- Placing IV poles or ventilators outside the rooms to prevent excessive use of PPE
- Headbands with buttons to prevent skin breakdown around the ears from masks
- 3D printing to make a variety of items
- Rapid deployment of educational resources
- Securement devices for Foley catheters to help keep tubing off the ground
- Tiered staffing models in hard-hit areas
“After the pandemic, we should continue to seek nurses out for their ‘in-time’ solutions as they need to continue to be supported, highlighted and championed for their creative solutions,” Brunson said.
Attraction to ICU Nursing Post-COVID-19
Nurses willingly volunteered to help in COVID-19 hot zones, such as New York City. Many traveled from all over the country to lend a hand. People looked up to nurses, some called them heroes. That may help increase interest in nursing as a profession and decrease the nursing shortage.
“The strength of the current workforce is shining a light on a profession that has been named the most trusted profession for the past 18 years, [according to Gallup surveys],” Brunson said. “With the impact of nurses being highlighted in major media outlets, I am optimistic we are inspiring others to step forward. But now there is a deeper understanding of what we do, plus it has shined a bright light on the critical thinking and compassion essential in the profession.”
Additionally, she said, “nurses are boldly proclaiming they are so proud to be a nurse, despite the challenges.”
Ethical and moral conflicts
ICU nursing entails life-and-death matters, even in normal times. But the sheer volume of death has been high during the COVID-19 pandemic.
Chaney said she found it stressful that patients were dying not surrounded by family, because “it went against everything we are taught.”
Nurses debrief with respiratory therapists and intensivists after every code at Mercy to process everything that happened and share their feelings.
“We need to keep in the forefront of our minds the impact as it relates to the health and well-being of nurses,” Brunson said. “We can already visually see the physical impact – mask sores, exhaustion – but we have a longer-term component long after the care of these patients has passed from moral distress and burnout.”
Those effects can alter the capacity of nurses to provide optimal care.
Brunson added, “Hospitals must also seek out and weave into the fabric of nursing departments tools and resources to address ethical and moral distress.” This can include encouraging staff to speak up, ask questions, escalate concerns and celebrate courageous care, she explained, especially when confronted with altered standards of care or scarce resources.
Chaney praised Mercy’s administrative and managerial support during the pandemic.
Post-COVID-19, “emotionally, we are going to be stronger,” Chaney said. “We are all looking after each other to make sure everybody is protected. We’re ready to take it on.”
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