Roxanne Aldi-Quaresima, MSN, RN-CCRN, is director of nursing at Hartford HealthCare in Hartford, Connecticut, and Wendy Napolitano, MSN, RN, is the clinical nurse manager of The Hospital of Central Connecticut’s intensive care unit. They shared a staffing solution that helped their ICU during the pandemic.
Our critical care unit at The Hospital of Central Connecticut innovated nurse staffing during the COVID-19 pandemic to support frontline staff and COVID-19 patients.
We used the Society of Critical Care Medicine’s (SCCM’s) Tiered Staffing Strategy for Pandemic model. Its goal is to adapt a tiered staffing model to support large patient numbers in critical care requiring mechanical ventilation. It calls for dedicated staff to manage a critical level of care and dedicated staff to provide overall patient care and support utilizing staff ratios to augment critical care needs.
Team Structure
Using SCCM’s recommendations for pandemic teams, unit leaders identified a team of nurses and developed a strategic course of action:
- Intensive Care Unit (ICU) nurses and providers oversaw and delegated tasks to non-ICU staff. This was an asset to assist with care for the COVID-19 patients.
- High-performing nurses were identified in the medical-surgical areas, operating rooms, post-anesthesia care unit and other outpatient areas that would otherwise not have been working due to decreased or a non-existent patient population. Nurses were oriented and introduced to the ICU arena and worked under the guidance of seasoned staff.
- Staff members were able to give medications, prime intravenous fluids, help the proning team turn patients and provide general care for the patient.
- Redeployed staff worked within their scope of practice.
Model Training
Orientation for redeployed staff involved an acute training module:
- Educational PowerPoints
- Tip sheets
- SSCM module for mechanical ventilation management and acute respiratory failure
- Personal Protection Equipment donning and doffing
In addition, physical therapists and ancillary staff were redeployed and trained on pronation therapy in order to develop a proning team. That team was a tremendous help. It can be very time consuming for staff to get into a room to prone a critically ill patient. The proning teams carried out a necessary task that, in turn, freed up other ICU nurses.
Group Effort
The support provided to the critical care team during this time was immeasurable. For all the stress that COVID-19 brought, there were many favorable outcomes. Team nursing built collaborative partnerships and brought nurses from different levels of experience together to care for our most critically ill patients.
Critical care nurses were supported at the bedside by their peers. The ICU nursing staff had the ability to delegate tasks to ensure the highest level of care. From helping in rooms to transporting patients and administering medications, the redeployed staff went above and beyond to help support the critical care team. The teamwork was unprecedented and the team-staffing model revealed a change on how to provide patient care during a pandemic. The team-staff model also will innovate the future of nursing practice. Staff from other departments learned more about the functions and operations of the ICU.
This model built collaborative team relationships and improved staffing models and patient care. As a result, during the pandemic not one nurse was furloughed at our facility.