October 12, 2021 – The nation’s filling of ICU beds has been the headlines for months now. As waves of COVID-19 spread across the country, hospitals have been pushed to capacity.
You can read the headlines about the lack of intensive care beds, but it can be hard to imagine exactly what that looks like. How does it affect patient care throughout the hospital? What is the form of employment? What about providing resources to the right people?
Here’s a glimpse into the domino effect of a system in crisis.
From normal to surplus
To understand the impact of full or overloaded intensive care units, it is important to understand what is happening in these critical hospital units.
“Before the pandemic, intensive care units generally provided care for patients with respiratory distress, sepsis, strokes, or severe heart problems. “These are people who are very ill and need ongoing care.”
It is generally recommended that nurses allocate these units in a ratio of 1 to 1, or sometimes in a ratio of 1 to 2. These are patients who require specialized equipment not found elsewhere in the hospital, such as ventilators, dialysis, specialized cardiac catheterization machines, And banks, among other things.
These patients also require multiple lab measurements, often taken hourly, and rapid medication changes. “Their circumstances change quickly and often, so you don’t want to miss an assessment,” Abraham says. “But when we have to increase the ratio of nurses to patients, we can’t monitor patients like we should.”
Today, intensive care units are filled with extremely sick COVID patients, as well as these “normal” critically ill patients, with dire consequences. “The lineage had to expand far beyond what is standard,” Ibrahim explains. “You might have four to six nurses with one patient.”
COVID patients often need to be put face down by staff, for example. To do this properly and safely, an entire team must be in place to prevent the tubes and lines from exiting the patient’s body. And when COVID patients require intubation, nurses, doctors, respiratory therapists, and others should be involved. All of this pulls these essential employees away from their other duties and normal care activities.
Full ICUs also require nurses and other staff who are not specially trained and certified to intervene in critical care. “These nurses still care for other patients, too,” Abraham says. “When a patient bumps and the nurses aren’t trained for it, the quality of care suffers.”
Where ICUs had an admissions nurse and space for a new patient, that would be a luxury, says Megan Bronson, a critical care nurse at Medical City Dallas Hospital, who spoke on behalf of the American Society of Critical Care Nurses. “Everyone hopes he won’t get new admission in their shifts,” she admits.
There was already a nursing shortage before the pandemic, and the stress of healthcare-filled intensive care units is making the problem worse.
Bronson says the crush of COVID has reached a national crisis.
“More important than talking about the number of beds available is how many nurses we have,” she says.
“As intensive care units get busier and larger, care is hurting,” she says. “That’s not what the nurses wanted, or why they entered the field.”
A survey conducted by Vivian Healthcare in April found that 43% of nurses are considering quitting during the pandemic, including 48% of ICU nurses.
It’s not just nurses. Doctors are also considering leaving the professional. A study was published in April in JAMA Network is open It found that 21% of all health care workers “moderately or very seriously” are considering leaving the workforce, and 30% are considering cutting their hours.
Post intensive care unit
As the intensive care units fill up, the effect is compounded throughout the entire hospital. “The only thing no one talks about is the fact that our supply tanks are gone,” Bronson says. “We are trying to troubleshoot around that. We are also still in the rationing of PPE [personal protective equipment]After all this time.”
Every 4 hours, Bronson says, hospital staff gather to decide where to send resources. “In the case of sorting, there is only so much you can do with what you have,” she explains. “We can only take care of priority needs.”
Often today, Abraham says, emergency rooms must accommodate critically ill patients. “Emergency care doesn’t stop there,” she says. “Patients are still coming in. There is less monitoring and less calibration [adjusting meds]and, in some cases, sending ambulances to other hospitals.”
The bottom line, according to Abraham, is that full ICUs require hospitals to bypass all of their standard procedures.
“This is never a good thing because it leads to a delay in care,” she says. “Patients in critical condition go to floors without specialized personnel, and mistakes can happen.”
On top of it all, the nurses and other staff were overworked.
“The nurses quit or move to places that are less stressful,” Bronson says. “Many of them became traveling nurses because they can make a lot of money in a short period of time and then take a break.”
In her opinion, Bronson says, the most important thing is having the right nurse for the right patient. “I’m in an adult unit but I had to check out a pediatric nurse that day,” she says. “She was quick to learn, but still limited by her training.”
Despite all this, both Abraham and Bronson pin hope for a brighter future in the nation’s hospitals.
“I’m holding my breath, but I’m an optimist,” Bronson says. “I have hope for 3 years down the road, but we need to provide new nurses to the system, vaccinate people, and a long-term strategy.”