2021 Annual Conference

Role of CNS in COVID-19 Pandemic

Title: COVID-19 Response: Preparing critical care registered nurses amid crisis

Significance & Background:
COVID-19 has infected over 20 million people. Five million cases and 165,000 deaths are in the USA alone, placing enormous strain on healthcare resources. Critical care RNs were scarce due to travel-nurse availability and state mandated nurse-to-patient ratios. The CNS and educator developed a succinct critical care education program for ambulatory surgery and PACU RNs. Didactic and hands-on education were utilized in preparing RNs to care for COVID+ patients in non-traditional ICU settings. As infections surged, additional RNs were needed to meet staffing demands, thus the education was amended for telemetry RNs with previous critical care or step-down experience.

Evaluation Methods:
Over a period of six days, PACU RNs (n=52) and ambulatory surgery RNs (n=26) were provided a critical care refresher program. Furthermore, telemetry RNs (n=11) were trained and additional education is scheduled. The program focus included medication titration, critical care RN role during Code Blue, delirium assessment and prevention, sedation assessment, ventilator management, ICU assessment and documentation, arterial line management, and high flow oxygen delivery. RNs self-evaluated their familiarity of critical care skills utilizing a 7-point Likert scale, before and after the program. Results were analyzed using a 1-tailed paired t-test.

Outcomes:
The learners completed a pre- and post-intervention survey. Paired t- tests showed statistically significant improvement with familiarity in roles during Code Blue (p=0.04), sedation titration (p= 0.005), delirium prevention (p= 0.008) and assessment (p= 0.006), sedation assessment (p= 0.04), vasopressor titration (p= 0.008), ICU assessment and documentation (p= 0.004), ventilatory management (p= 0.03), and arterial line management (p= 0.002). Although not statistically significant, familiarity with insulin titration (p= 0.15) and high-flow oxygen delivery (p= 0.11) did demonstrate improvement. Further data to be presented upon acceptance.

Implications:
The collaboration between CNS and educator is imperative in preparing staff RNs to safely care for critically ill COVID-19+ patients. Moreover, it is essential to review existing staffing resources to identify RNs whose skills may be further developed in a pandemic. It is necessary to consider nursing learning needs, hands-on skills, and previous experience when developing an appropriate curriculum for providing high-quality, complex patient care.