Pandemic – Critical Care Nurses: Strength through Unity

During the pandemic, the Intensive Care Unit implemented an original solution to rapidly train its nurses: The triad. Discover it.

Being an intensive care nurse during a pandemic

Normally, to work in the intensive Care Unit (ICU), a nurse undergoes 40 days of training upon her arrival, which is far too long a delay to adequately deal with the onset of the pandemic.

The department therefore implemented an original solution that has reduced training time to only… four days. Mylène Ostiguy, Nursing Consultant, Intensive Care and Coronary Unit at the CIUSSS de l’Est-de-l’île de Montréal, explains how they were able to adapt.

How did this triad come together?

M. O.: The rapid need for new nurses to deal with the pandemic required a great deal of adaptation on our part.

It was impossible to train all 75 new nurses in 40 days. We didn’t have that time. So, we juggled with patient-to-nurse ratios. Normally, one ICU nurse would be caring for two patients. At times, she may even have only one patient, depending on the latter’s condition.

We had to increase this ratio to four patients per nurse. To ensure safe care, the two nurses with the shortened training (referred to here as “novice” nurses) were paired with a nurse with critical care expertise (referred to here as the “leader”). The two novices provided basic patient care and were supervised and accompanied by the nurse leader. They formed a triad.

Can you break down these four days of training?

M. O.: Even in a crisis, you have to be able to adapt and react quickly.

Teamwork

My colleagues, Marjolène Di Marzio, Nursing Consultant, Julie Bissonnette, Clinical Nurse, and myself, began training nurses with a 2-hour theory course.

Adapting and questioning oneself

We quickly realized that this recipe was not good. The stress of the novices was increasing as the knowledge was being passed on.

We then transformed the training into four practical workshops that covered common situations in the Intensive Care Unit. The two hours of theoretical training were then transformed into a half-day of practical training.

The value of interprofessional collaboration

And to show the exemplary collaboration that reigns in our CIUSSS, a nursing consultant from the Nursing Department, with a few years of experience in intensive care, Guillaume Canuel, came to lend us a hand.

From left to right: Mylène Ostiguy, Guillaume Canuel, Julie Bissonnette et Marjolène Di Marzio

Simulations allowed the new nurses to work on care techniques that are rarely used in their own services or specialties, even though they are part of the basic training.

We added theoretical slides to these simulations, to provide a better understanding of the specifics of intensive care. Afterwards, they had three days of “floor” training where they were paired up with expert intensive care nurses to learn the department’s routine.

Checklists and theoretical notions on various topics pertaining to intensive care as well as several tools to help them untangle the various forms used were sent by e-mail.

Much was said about Dr. Marquis’ mannequin. What role does it play in this training?

M. O.: Unfortunately we were not able to use the high-fidelity simulation dummy for the COVID training. We had too many nurses to train at the same time and only one dummy, which was very popular. So, we opted for practice laboratories that use only the necessary equipment (practice arm, intravenous pump, syringes, medication vials, etc.).

Under normal circumstances, we use the high-fidelity dummy for various simulations: resuscitation, massive transfusion protocol, intubation, etc. It helps nurses gain confidence in handling new equipment in a safe environment. It also helps them develop clinical judgment, teamwork and collaboration, all of which are essential skills for a critical care nurse.

On the same topic

˃ Read Pandemic – Critical Care Nurses: The Training Challenge. 

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