Upskilling Nurses for COVID-19 Care

A few hours into her recent shift at Memorial Medical Center, registered nurse Heather Reiss was caring for two COVID-19 patients in an intensive care unit and learned two more patients would be brought to the unit soon and placed under her care. But Reiss, a longtime ICU nurse, had support in meeting that demand. Another nurse – one from a different department who had received special training to help care for COVID-19 patients — was there to assist her, and all four patients received the same high level of care. “We actually were able to meet the needs of the patients better,” said Reiss. “We felt a great sense of satisfaction when we were done.”

To prepare for a potential surge of COVID-19 patients in coming weeks and months, Memorial Health System has trained 580 of its nurses to function as part of teams in ICUs and other areas. About 300 of the trainees are at 500-bed Memorial Medical Center in Springfield. Many of these nurses were unaccustomed to the rigors of serving often unstable and critically ill COVID-19 patients, and at the same time trying to prevent others from being infected by the novel coronavirus.

The training program, called “upskilling,” includes classroom instruction, written materials and on-the-job mentoring. More than 50 of Memorial Health System nurses already have begun working in new roles as part of teams directed by more-experienced colleagues. The upskilled nurses have helped care for COVID-19 patients in ICUs and in other hospital units affected by changes in staffing levels related to the pandemic, according to Jennifer Bond, vice president of nursing.

Memorial Health System’s five central Illinois hospitals in Springfield, Decatur, Jacksonville, Taylorville and Lincoln have treated several dozen COVID-19 inpatients so far but haven’t experienced the significant influx of patients seen in Chicago, New York City and other “hot spots.” “Now we have a little bit of lead time, when we can plan,” said Dr. Raj Govindaiah, the system’s chief medical officer. “We can train people in a way that you can’t when you have an immediate need. I think it has worked out pretty well.”

Springfield Clinic pulmonology physicians so far have been trained to help care for COVID-19 patients in an intensive care environment. If necessary, more physicians will be trained to work in the emergency departments of Memorial Medical Center and Decatur Memorial Hospital, and as hospitalists in both institutions, Govindaiah said. System officials have designated those two hospitals for the sickest COVID-19 patients should a surge occur due to the large number of specialty physicians and nurses already working there.

Even though the number of surgeries are down 60% because of the postponement of non-urgent surgeries, Memorial continues to treat many critically ill patients, including those dealing with influenza and other respiratory illnesses, heart attacks and strokes, Bond said. With overall inpatient volume down 35% throughout the system, the training program has given many nurses the opportunity to keep working so they don’t have to take paid time off, she said. The program has increased camaraderie among nurses from different parts of Memorial Medical Center, according to Audra Chestnut, system director of organization learning. “They get to step into someone else’s world and see how it functions,” she said.

MMC registered nurse Abby Mustread has cared for COVID-19 inpatients in non-ICU areas since mid-March. She said the upskilling program improved her ability to spot subtle changes in patients’ conditions so she can set in motion potentially life-saving interventions earlier. “It’s helped me learn more about the illness and how to recognize symptoms of decline in patients,” she said. Mustread, 22, who graduated from nursing school only 11 months ago, said, “It’s been the biggest learning experience, though I wish it were under different circumstances.” Kimmy Eldridge, a nurse for 26 years who has cared for COVID-19 patients in intensive care and other inpatient areas of Memorial Medical Center, said she would supervise upskilled nurses from other areas during a surge. She said she supports the training program because it would provide more help for nurses who are caring for patients on ventilators and monitoring the intravenous medicines those patients receive for sedation, breathing and pain.

Both she and Reiss said extra sets of hands and eyes are helpful in settings that are stressful for the staff, patients and loved ones. Visitors haven’t been allowed during the pandemic, and nurses often are the ones who are with dying patients as loved ones say their good-byes via FaceTime on iPads. To minimize potential exposure, housekeepers and phlebotomists rarely go into the rooms of COVID-19 patients. The situation creates even more of a burden for nurses, who take on more tasks and become patients’ lifeline to the outside world, Mustread said.

Nurses who work with COVID-19 patients and those suspected of COVID-19 infection wear gloves, a gown over their scrubs, a hood and a device that filters air from the room. To patients, nurses can look like astronauts on a moonwalk, but Eldridge said nurses do their best to soothe patients’ nerves. Nurses feel relieved when they see COVID-19 patients recover and go home — a scenario that plays out in the vast majority of situations, she said.

Mustread said the upskilling training has been valuable because patients can rapidly decline. Such rapid changes can require patients to be quickly transferred to an ICU, where the presence of upskilled nurses working can prevent veteran ICU nurses from becoming overwhelmed, Reiss said. “The team concept is definitely going to be life-saving,” she said.