Nurses and COVID_19

The vital contribution of nurses to the COVID-19 response

World Health Day is this year shining a light on the contribution of nurses and midwives to healthcare delivery and as health systems around the world work to boost their workforce capacity to cope with the COVID-19 pandemic, the role of nurses has never been more vital.

In Australia, nurses who have left the workforce are being recalled to duty and those already in the workforce are being asked to retrain so they can work in intensive care where they will be needed most.

We spoke to Frances Bass, ICU Research Nurse (Royal North Shore Hospital) and Project Manager, Critical Care Division at The George Institute about the challenges and opportunities those answering this medical ‘call to arms’ may face.

The critical care environment is obviously a little different to general nursing, but even more so in a pandemic situation. What challenges do you think nurses new to the ICU environment could encounter?

The Intensive Care Unit (ICU) is a very technical environment, run and staffed by a team of highly trained health clinicians caring for critically ill patients. As Australian ICUs prepare for a potential surge in admissions due to COVID-19, hospitals around Australia have created educational sessions and resources to enable effective and safe training for non-ICU staff. ICU nursing is a skill that is acquired with hands-on training and additional study, so non-ICU nurses will most certainly face challenges not only in respects to the technical environment, but also the clinical complexities, the acuity of the critical care patients, additional caring care of their own emotional and mental wellbeing. These nurses should however not be scared to take on the challenge. The plans in place ensure that all non-ICU nurses are provided with appropriate training and learning packages, they will be working with experienced ICU clinicians at all times and will be delivering nursing care to an expected and realistic standard for new nurses working in ICU.

As a past critical care nurse, what would your advice be to those considering retraining for ICU?

Please, consider retraining!

Although I am not clinical in my current role at Royal North Shore Hospital in Sydney, I will be called to the front line when directed. As I face this situation myself, my advice to past critical care nurses is to considering retraining - contact NSW Health to enquire what is required to re-establish registration, and be retrained. There are many free online courses that can be accessed to re-skill or upskill in critical care nursing (Australian College of Critical Care Nurses – ACCCN - have free online learning modules). I am fortunate that I already work in the ICU Department and training/upskilling has commenced. There is also a plan in place for registered critical care nurses in managerial and administrative positions that will be actioned when required.

How are concerns about the personal risk to nurses of being on the frontline being managed and what kind of support is available to help nurses manage the stress associated with this new environment?

Understandably, personal risk on the frontline is an area of great concern and anxiety not just for nurses but all health professionals and hospital staff. What has been effective at the hospital I work in is informing and providing staff with up to date and relevant COVID-19 information, having regular weekly meetings in each ‘ICU pod’ via video conferencing lead by senior Intensivists and Nursing Unit Managers, also providing weekly ICU newsletters of facts and support, connecting on private groups via Facebook, using the available Employee Assistance Program (EAP) service, having staff information procedure checklists to remind staff of the best way to protect themselves and their families when returning home. Additionally, senior nursing staff and nurse educators are providing streamed simulation education training for all staff caring for a COVID-19 positive or suspected patient including intubation and ventilation. There has also been a huge focus on appropriate donning and doffing of Personal Protective Equipment (PPE).

Why did you choose critical care as a career?

Initially I had my sights set on working as a nurse in the Emergency Department but during my new graduate program at St Vincent’s Hospital in Sydney I had the privilege to be placed in ICU and found my time there incredibly stimulating, sometimes challenging yet ultimately, extremely rewarding. I continued working clinically in ICU for many years and my ICU experience enabled me to travel overseas and work in many different hospitals within the NHS in Scotland and England. Once I returned to Australia, I continued in ICU and was fortunate to work in a part time ICU Research Coordinator position - this was an amazing opportunity and was the turning point for me, that I was able to work in ICU and to be involved in critical care research. I am now privileged to work as an ICU Clinical Research Manager at Royal North Shore Hospital and also as a Project Manager within the Critical Care Division at The George Institute.

What qualities make a good critical care nurse?

Qualities that enable critical care nurses perform day after day regardless of the circumstances are having a strong clinical knowledge, excellent communication skills, being able to work in a dynamic multidisciplinary team, excellent time management and importantly the skill to communicate with patients and their families during an extremely difficult time.  Traits such as resilience, adaptability, patience, being respectful, kind, able to multi-task and most importantly, having a wicked sense of humour make for a great nurse. More often than not, nurses will always see the positive side of life, uplift a bleak situation and certainly live life to the fullest and embrace what is dished up at each shift.

How well prepared to do you feel the country’s health system is to face this unprecedented challenge?

As we are in unchartered territory having never faced a situation like this before it is certainly a very concerning and challenging time for all. In Australia, we have an excellent public health system, we have an established medical College of Intensive Care Medicine, the oldest Intensive Care Society in the world (Australia and New Zealand Intensive Care Society or ANZICS) and an established College of Critical Nurses (Australian College of Critical Care Nurses - ACCCN). We have extremely dedicated, experienced clinicians and leaders that have been working effectively as a team to produce COVID-19 guidelines, prepare all ICUs for a never before seen influx of patients and preparing satellite ICUs in a very short time frame. Both medical and nursing leaders in all metropolitan and rural hospitals have been working tirelessly in preparation of the expected worst-case scenario. The ICU medical and nursing leaders and the multidisciplinary teams have been nothing short of inspirational and outstanding. We will get through this pandemic, it will pass.

How do you think this might change the critical care nursing workforce in the future?

I feel that globally there is already a change to the way the world is viewing critical care nurses and health care professionals. The COVID-19 pandemic has brought critical care nurses to the forefront of people’s minds and the media attention and public gratitude towards health care professionals is being captured internationally on a daily basis.  As not everyone understands what happens in an ICU, and the COVID-19 pandemic has shown the high-level skills and knowledge of what this important group of clinicians do on a daily basis, I hope that we as a group, grow professionally and that nursing enrolments into critical care nursing increase. This year, 2020 is the year of the Nurse and Midwife and there is no time like the present to celebrate and be proud to represent critical care nurses and the rewarding profession that I am fortunate to be a part of.

Anything else you would like to add?

As an ICU research nurse it is inspiring to see the amount of research being conducted on COVID-19. With this new disease, we really don’t know how best to treat it. Undertaking research enables us to provide clinicians with the best evidence to address this clinical uncertainty. Critical care research has never been more important to ICU patients, their families, health care clinicians and global society as it is now.