Team Care and Nurses' Cross-training Made Possible by COVID

The latest COVID-19 wave has strained healthcare resources, with hospitals implementing team-based care, cross-training hospital nurses and boarding patients in the emergency department.

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Team Care and Cross-training for Nurses Made Possible by COVID

“With the most recent surge in patients with COVID-19, nurses are once again being asked to help in units that may be unfamiliar to them,” said Julie Miller, BSN, RN, CCRN-K, clinical practice specialist, American Association of Critical-Care Nurses (AACN). “Some hospitals are using these nurses in team roles where they can use the skills and knowledge they have from their prior nursing practice to provide care to patients in a different type of unit.”

How does nursing team-based care work?

In the team role, Miller explained, “a medical–surgical nurse may be asked to monitor intake and output, administer IV and oral/gastric tube medications, assess and intervene for pain, assist with prone positioning, perform uncomplicated dressing changes, and if possible, implement early mobilization strategies.”

“With these nursing interventions managed by the medical–surgical nurse, it frees the ICU nurse to assess and intervene with vasoactive drip titration, paralytic and sedation management, management of ECMO (extracorporeal membrane oxygenation) and CRRT (continuous renal replacement therapy),” she continued.

Additionally, she said, “nurses who are floating to ICUs to help may be also asked to learn new skills, such as how to suction an endotracheal tube or to level and zero hemodynamic monitoring lines.”

That education within the unit helps reinforce specific skills or protocols learned from online resources, while minimizing time away from the unit, Miller added.

“Nurses are also using the AACN Clinical Practice Community to seek creative solutions to cross-training and different clinical situations.”

Cross-training hospital nurses

“Nurses often work alongside a more experienced nurse while they are being cross-trained, allowing them to develop confidence in their new skills and knowledge,” Miller said.

Nurses required to cross-train can also avail themselves of online AACN resources, such as AACN’s Essentials of Critical Care Orientation. More than 130,000 individuals have accessed AACN’s free COVID-19 Pulmonary, ARDS and Ventilator Resources course, since it was launched in March 2020. AACN established one of the first micro-credentials for healthcare professionals during the pandemic, based on that course.

The micro-credential “is a great way for nurses to validate knowledge in caring for mechanically ventilated patients and demonstrate their expertise to potential employers,” Miller said. 

Benefits to cross-training hospital nurses

“There are definite benefits to cross-training as it exposes the nurse who is cross-training to new experiences and familiarizes them with the challenges nurses face in that unit,” Miller said. “The opportunity to develop new collegial relationships is a definite benefit to floating and cross-training.”

Inter-unit cooperation builds relationships. The key to successful floating or cross-training is ensuring those nurses receive the support they need.

“It also provides them with the opportunity to empathize with the nurses who they may have only previously received or given report to, and not had the opportunity to truly experience the successes and challenges those nurses face,” Miller continued.

Miller reported that some nurses who have cross-trained to the ICU found they really enjoyed the experience and put in for a transfer to begin their critical-care careers.

Boarding in the emergency department

Another staffing concern is boarding critically ill patients in the emergency department, which occurs when the patient needs to be admitted but no inpatient beds are available. This has long been a problem but has gotten worse during the pandemic, said Ron Kraus, MSN, RN, EMT, CEN, ACNS-BC, TCRN, president of the Emergency Nurses Association.

Emergency department nurses have the skills to provide critical care, even though they have migrated to practicing in a fast-paced environment and helping stabilize the patient and discharging to home or to an inpatient room.

“The patient is receiving care,” Kraus said. But “it puts a strain on the emergency department nurse.”

And that “inability to transfer patients to critical care has a detrimental impact on throughput,” Miller said. “Having to hold patients in the ER severely impacts the ability to accept new patients who also need emergency services.”

Creating new opportunities for nurses

Learning new critical care skills and providing team-based care could open up additional professional opportunities for nurses by making them more employable.

“Employers want to see what type of experiences and skills their prospective employees will bring to the role that will complement and add to their current pool of nurses,” Miller said.

“In the current environment, we are seeing many nurses take on travel nursing,” Miller added. “Travel nursing definitely requires a nurse to have excellent assessment, critical thinking and effective decision-making skills, but it also requires a nurse to be flexible and adaptable since they will be dealing with new work environments frequently.”

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