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INTRODUCTION

The COVID-19 healthcare crisis caused significant strain on health care professionals such as nurses. Protocols were implemented to guide with staffing, medication administration, providing nutrition, and moving patients from supine to prone position while ensuring the safety of the nurses.

Nurse Staffing

In a survey performed by the American Association of Critical Care Nurses (AACN), out of 164 ICU nurses, 39% had less than two years of experience and 73% had less than five.1 The recent COVID-19 pandemic forced a crisis of standard of care where health care resources, including nursing staff, were limited. This forced many non-ICU nurses to assume care for ICU level patients.1

The SCCM published a tier-based model taken by the University of Pittsburg Medial Center for surge staffing of critical care physicians and nursing under crisis.2 For every 24 mechanically ventilated patients, the unit should be staffed with 4 ICU nurses and 12 non-ICU nurses.3 Each nurse must be familiar with the unit including where intubation boxes, intubation medications, and code blue carts are located. Because hospitals under crisis may stop or slow surgeries, the operating room (OR) and post-anesthesia care unit (PACU) staff become available to incorporate into the model. Nurses who may not have ICU experience but are familiar with devices such as ventilators used in ORs are beneficial in assisting in the care of the ICU patient under crisis.3 Other hospitals recruited nurses with prior critical care experience to return to critical care units during pandemic-related surge capacity.4 The SCCM also suggests incorporating intermediate care, telemetry, or stepdown nurses into the team-based care approach similar to SCCM’s model.4 For nurses returning to the bedside after six months or more away, a surge plan orientation, skills lab, shift with a preceptor, and e-module training should be offered.5–7 Validation in essential nursing skills such as assessment, medication administration, documentation, and dressing changes is recommended. Furthermore, it is recommended that these nurses assist with patient assignments but not take their own full patient load.5

Nurse Safety

According to the AACN, nurses spend an average of 33% of their shift at the bedside contributing to both health and safety concerns and fatigue.1 Nurses who had became infected followed hospital protocol and quarantined with location and duration depending on severity of symptoms.8,9 Nurses were under significant psychological pressure at the bedsides of critically ill and dying patients of a poorly understood disease.8 Based on research from previous pandemics such as SARS, MERS-CoV, Ebola, and H1N1, nurses suffered from anxiety, depression, physical and mental fatigue, insomnia, and post-traumatic stress after being in close contact with patients with these diseases. With the Ebola pandemic, 45% of caregivers sought psychological counseling and 29% felt lonely. Depression was present in 38.5% of nurses during the SARS pandemic while 37% experienced insomnia ...

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