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, taking on the brunt of the care required for seriously ill patients with the novel coronavirus. The country is nowhere near the end of the pandemic. When cases eventually slow down, 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).

“With cases of COVID continuing to soar, this pandemic is testing the capacity of our system,” 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.”

FIND travel ICU nursing jobs around the U.S.

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.

Innovation

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

“The demands placed on caregivers in this pandemic are immense and challenge them personally as well as professionally. The detrimental effects of burnout and moral distress not only corrode our well-being, they can also impact our capacity to provide the best possible patient care,” Brunson said.

In response to the growing burden of stress on nurses, AACN has partnered with the American Nurses Foundation, American Nurses Association, American Psychiatric Nurses Association and Emergency Nurses Association to establish The Well-Being Initiative, which provides free tools and resources to support nurses’ mental health and well-being.

Heading to Hot Zones

Nurses willingly volunteered to help in COVID-19 hot zones, such as New York City. Then as the pandemic wore on through the summer, Houston and Miami needed nursing help. Florida’s governor sent 100 contract nurses to the city to care for patients with the virus. 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.

“Surging to a level where ICU capacity is full is really a scary time, and I think to truly understand what that actually means it’s important to understand what goes into ICU level of care” said Kevin Smith, MD, FACP, FAAP, chief medical officer of Loyola University Medical Center in Maywood, Illinois. “When you talk about getting to a level where you have your actual capacity, that really means that there's not a lot of good options of where you can put these patients and deliver really high levels of care. And in some of these cases, the patients who have COVID are sick – and for some of these patients they are far and away the sickest patients in our hospital and so not just anybody could come in and care for them.

Attraction to ICU Nursing Post COVID-19

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.”

ICU Nursing Jobs: Bringing Hope to Critically Ill Patients