Opinion

Why the ICU nursing shortage can be ignored no longer

COVID-19 second wave will challenge depleted workforce, no matter how many new beds there are

COVID-19 second wave will challenge exhausted and traumatised staff, even though our knowledge bank is greater this time around

ICU staff have been providing critical care in the most challenging circumstances for months

So here we are. COVID-19 is still with us, the country still has lockdown measures in place to varying degrees and the NHS is facing both continuing and new challenges.

I said back in March that intensive care units (ICUs) are about more than beds and ventilators : months on, I am making the same point.

Governments claims about intensive care bed capacity

The government says the UK now has four times the number of ventilators than we had in March (30,000, up from 7,400),

COVID-19 second wave will challenge exhausted and traumatised staff, even though our knowledge bank is greater this time around

A critical care ward, showing nursing staff monitoring patients in beds
ICU staff have been providing critical care in the most challenging circumstances for months

So here we are. COVID-19 is still with us, the country still has lockdown measures in place to varying degrees and the NHS is facing both continuing and new challenges.

I said back in March that intensive care units (ICUs) are about more than beds and ventilators: months on, I am making the same point.

Government’s claims about intensive care bed capacity

The government says the UK now has four times the number of ventilators than we had in March (30,000, up from 7,400), and in October prime minister Boris Johnson confirmed that 40 hospitals will be built by 2030.

Good news, certainly, but the elephant-in-the-room question remains: what about the nursing staff?

Ventilators do not just require switching on, they need highly specialist, skilled intensive care unit (ICU) nurses to use them in response to the assessment of a patient’s physiology.

Calling nurses angels does nothing to ensure adequate staffing levels

This appears to be a message that is simply not getting through. There is a disconnect here, with the representation of nurses as angels and heroes on the one hand, and the failure to ensure adequate staffing on the other.

We are seeing a second spike in COVID-19 admissions, with a potential further increase in ICU demand.

‘If we cannot redeploy staff from other areas, how does an already exhausted ICU nursing workforce cope with a rise in COVID-19 admissions coinciding with seasonal flu?’

It’s true we have some significant advantages this time. Better knowledge and understanding of the disease trajectory and treatment for COVID-19 patients. Better access to vital equipment and drugs. Better access to crucial personal protective equipment.

However, we are heading for a perfect storm.

Critical care nurses are exhausted – they have seen death on a new scale

ICU nurses are physically and psychologically exhausted. Many are off sick with significant mental health issues due to their experiences of managing the first COVID-19 surge.

They have seen death on a scale not experienced before. They have been unable to support families grieving for loved ones.

They are scared of taking the virus home to their families. They have lost family members, friends and colleagues. They have been unable to deliver the gold-standard care that they are usually so proud of and that is the reason they work in critical care.

Response of redeployed staff was outstanding – but they won’t be returning to ICU

During the first surge, all non-emergency NHS services were suspended, enabling staff to be redeployed into critical care to support ICU nurses with the tsunami of patients they faced.

A nurse in scrubs wearing a face mask, who is sitting down and looking exhausted
Some staff are physically and emotionally
depleted by their experiences Picture: iStock

Their response was outstanding. It must be truly terrifying to be sent into an ICU with no prior knowledge or expertise in the area to support the care for the sickest of patients.

Huge amounts of work have been undertaken by organisations, NHS providers, clinical educators and academics to cross-skill staff in the basics of ICU.

However, the government has made clear that in the event of a second surge, suspension of normal NHS activity is not possible.

While I understand the rationale for this and empathise with patients who have been affected by cancelled operations and delays in treatment, we do need to address the implications for ICU nurse staffing.

‘If we see a second surge and the volume of admissions seen previously, we simply do not have enough ICU nurses. No matter what spin is put on this, these are the cold hard facts’

If we cannot re-deploy staff from other areas because those areas will still be required to function, how does an already exhausted ICU nursing workforce cope with a further rise in COVID-19 admissions coinciding with seasonal flu?

We must capitalise on the attention critical care is attracting

There are always positives to be found in the most difficult of situations. For me this is teamwork – the huge effort by everyone involved in critical care pulling together to support each other and get through this.

The boosted profile of critical care and the critical care nurse, particularly, is an amazing opportunity for our specialty, one we need to harness to improve how we work in the future, for the benefit of both patients and staff.

Nursing shortages and the reasons staff leave must be addressed

If we see a second surge and a repeat of the previous volume of admissions, we simply do not have adequate ICU nurses. No matter what spin is put on this, these are the cold, hard facts.

Prevention is key – stopping the transmission of the virus, protecting older and vulnerable people, reducing hospital admissions and thus protecting our ICUs and their nursing staff.

Nurse staffing deficits must be taken seriously and the reasons nurses are leaving the profession identified and addressed.

We can’t just put a sticking plaster over the issues and hope they go away.


Nicki Credland, senior lecturer and chair of the British Association of Critical Care Nurses

Nicki Credland is senior lecturer and head of department for paramedical, perioperative and advanced practice at the University of Hull, and chair of the British Association of Critical Care Nurses

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