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The health care system has been significantly impacted by the volume of patients in need of critical care services. Hospitals in geographic areas with large spikes in cases have experienced bed shortages and supply chain issues, specifically with needed PPE, staffing shortages and even a loss of staff due to COVID-related deaths.

Vaccine distribution and inoculation has launched in many geographic areas and scientists are studying treatments that are most effective for those receiving care for complications, but there is still a dire need to treat incoming patients. At the time of this article, the World Health Organization (WHO) reports more than 100 million confirmed cases of COVID-19 and more than two million deaths worldwide. The U.S. represents more than 25 million of those cases and more than 400,000 deaths. There have been three known variant strains identified in the U.K., South Africa and Brazil which seem to spread easily, leading to additional spikes in cases and a dire need for treatment worldwide.

Hospital executives are working quickly to mobilize all available resources to meet patient care demands, impacting the entire continuum of care. With widespread systemic nursing shortages and burnout already a severe issue, health care systems face a significant challenge in responding to the pandemic and extreme staffing needs. Executives are expediting resource planning and mobilization strategies to combat the strain put on nursing resources, implementing multi-modal strategies to manage these shortages. Examples include:

Surge Planning for Critical Care Units

Many organizations are conducting evaluations of all available nurses with previous experience in critical care, specifically within the last three years, and mobilizing them into critical care units. Hospitals are also recruiting from adjacent areas such as the operating room or the emergency department, where nurses experienced in urgent care can be mobilized into critical care environments.

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Use of Traveler Nurses

Traveler nurses represent a growing trend in healthcare however due to COVID-19, the need to mobilize nurses is even more crucial. Traveling nurses often relocate where they can make the most salary, leading health care systems to compete to obtain travelers for their staffing needs. Traveler nurses also relocate to the greatest areas of need (generally large urban area hospitals), leaving smaller community hospitals with even greater staffing challenges.

Developing New Care Models

Nursing leaders are utilizing telemedicine approaches, remote electronic ICU monitoring and virtual nursing services, which support staffing models and leverage the most experienced nurses for ICU monitoring. Interprofessional team-based care models can support staffing by aligning scope of licensure to patient care needs, counteracting spikes in COVID-19 patients across the care delivery system. 

To be successful at meeting this important call of duty, nurses require support from leadership to meet their obligations. Nursing leaders are called on to manage workforce preparedness and meet staff competency needs and staffing demands. We are seeing various workforce preparedness initiatives implemented across the health care system, including:

Evidence-based Knowledge Dissemination

Research continues to emerge related to the novel coronavirus. Recommendations for testing, treatment options and prevention interventions such as vaccinations are coming in at a rapid rate. This new knowledge needs quick dissemination using the right tools to distribute at a fast, accurate pace to help keep nurses informed on evidence that impacts patient outcomes.

Refresher Programs

Skills training programs are being implemented to re-teach and reinforce basic nursing competencies and skills. These programs help mobilize nurses who have not been at the bedside recently and need a quick refresher to effectively assist with patient care staffing needs.

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Upskilling Programs

These types of programs help facilitate rapid validation of clinical competency. Evidence-based competency skill checklists and courseware is a great approach to meet the needs of upskilling and prepare a broader workforce for staffing availability during high census. In my work with nursing education leaders, the following competency topics were the most requested in 2020:

  • SARS Cov2 Coronavirus (COVID-19) Overview
  • Mechanical Ventilation Care
  • Donning and Doffing PPE
  • Nasopharyngeal Specimen Collection
  • Respiratory Assessment
  • Prone Positioning
  • IV Medication Administration
  • Blood Product Administration
  • IM Vaccine Administration

Nursing Impact

In 2020, we celebrated the “Year of the Nurse & Nurse Midwife.” The pandemic shines a positive light on the nursing profession and reinforces the importance of clinical practice and leadership. Nurses in all roles have leaned into their roles, sacrificing their own safety and well-being for the cause. Nursing is truly a calling.

Nurses have a very important and impactful role during the coronavirus pandemic. They are resilient and service-minded, putting the needs of others above their own. The pandemic has reinforced the importance of workforce preparation, mobilization of resources, and support for continuous learning and competency. We know what works and how to move quickly should we experience another pandemic. The lessons we have learned as a profession during this crisis will not be wasted and should propel quicker response and further preparedness expectations for the next call to action.

Diane Hanson, RN, BSN, MM, FNAP
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