HEALTH: As COVID Fills ICU Beds, Dominoes Fall Throughout Hospitals

dWeb.News Article from Daniel Webster dWeb.News

dWeb.News Article from Daniel Webster dWeb.News


Oct. 12, 2021 — The filling up of the nation’s intensive care unit beds has been headline news for months now. As waves of COVID-19 cascade across the country, hospitals have been pushed to capacity.

You can read headlines about ICU beds being short, but it may be difficult to visualize what that means. What does this mean for patient care? How does it affect staffing? What about staffing?

Here’s a snapshot of the domino effect of a system in crisis.

From Normal to Overflow

To understand the impact of ICUs that are full or over capacity, it’s important to understand what goes on in these vital units of the hospital.

“Prior to the pandemic, ICUs generally cared for patients with respiratory distress, sepsis, strokes, or severe cardiac issues,” explains Rebecca Abraham, a critical care nurse who founded Acute on Chronic, which offers help to patients navigating the health care system. “These are people who are very sick and need constant care.”

Allocation of nurses to these units is generally recommended on a 1-to-1, or sometimes 1-to-2 ratio. These are patients who require specialized equipment not found elsewhere in the hospital, like ventilators, bedside dialysis, specialized heart-catheterization machines, and drains, among other things.

These patients also require multiple lab measurements, often taken hourly, and rapid changes in medications. Abraham says that patients’ conditions can change rapidly and frequently so it is important to keep an eye on them. “But when we have to expand our nurse-to-patient ratio, we cannot monitor patients like we should.”

Today, ICUs are now full of very sick COVID patients, on top of these “normal” critically ill patients, with dire consequences. Abraham says that the ratios had to be increased beyond the standard. “You might have four to six nurses involved with one patient.”

COVID patients often need to be placed face-down by staff, for instance. A full team is required to safely and properly place the patient face-down. And when sick COVID patients require intubation, nurses, doctors, respiratory therapists, and others must be involved. This takes these staff members from their normal duties and prevents them from performing other essential care activities.

Full ICUs also require that nurses and other personnel who are not specifically trained and certified in critical care step in. Abraham says that these nurses still take care of patients. “When a patient crashes and the nurses aren’t trained for that, quality of care suffers.”

Where ICUs once had an admitting nurse available and a place for a new patient, now that would be a luxury, says Megan Brunson, a critical care nurse at Medical City Dallas Hospital who spoke on behalf of the American Association of Critical-Care Nurses. She admits that everyone hopes to not be admitted on their shifts.

There was already a nursing shortage before the pandemic, and the strain that packed ICUs is putting on health care is only making the problem worse.

Brunson says the crush of COVID has reached a national crisis.

“More important than the conversation surrounding how many beds are available is how many nurses we have,” she says.

Abraham agrees. “Care suffers as ICUs become busier and more stretched,” she said. “That’s not what nurses want, or why they got into the field.”

A survey by health care staffing company Vivian in April found that 43% of nurses were considering quitting during the pandemic, including 48% of ICU nurses.

It’s not just nurses. It’s not just nurses who are considering quitting the profession. An April study published in JAMA Network Open found that 21% of all health care workers “moderately or very seriously” considered leaving the workforce, and 30% considered cutting their hours.

Beyond the ICU

As ICUs fill up, the effect multiplies throughout the entire hospital. Brunson says, “One thing that nobody is talking about it is the fact our supply closets have been wiped out.” “We are trying to solve that.” We’re also still rationing PPE [personal protective equipment], after all this time.”

Every 4 hours, says Brunson, staff at her hospital huddle to determine where to send resources. She explains that in a triage situation there is only so much one can do with the resources available. “We can only take care of the priority needs.”

Abraham says that often today, emergency rooms must hold critically ill patients. She says, “Emergency care does not stop for that.” Patients are still coming in. There’s less monitoring, less titration [adjusting meds], and in some cases, sending ambulances to other hospitals.”

The bottom line, according to Abraham, is that full ICUs require that hospitals bypass all their standard procedures.

“That’s never a good thing because it leads to delays in care,” she says. “Critically ill patients go to floors without specialized staff, and mistakes can happen.”

On top of it all, nurses and other personnel are burned out.

“Nurses are quitting or moving to less stressful settings,” says Brunson. “Many are becoming traveling nurses because they can make a ton of money in a short period of time and then take a break.”

Brunson says that to her mind, the most important thing is having the right nurse for the right patient. She says, “I am on an adult unit, but had to call in a pediatric nurse yesterday.” “She was a quick learn, but she’s still limited by her training.”

In spite of it all, both Abraham and Brunson hold out hope for a brighter future in the nation’s hospitals.

“I’m holding my breath, but I’m optimistic,” says Brunson. “I have hope for 3 years down the road, but we need to crank out new nurses for the system, people to get vaccinated, and a long-term strategy.”

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