COVID-19 has taken me from surgeon to ICU nurse
With the support of our ICU nursing team, I am learning how to care for ventilated patients
Until two weeks ago, I was a thoracic surgeon at the James Cook University Hospital in Middlesbrough.
As I write, I will shortly be starting an intensive care unit (ICU) nursing night shift looking after ventilated patients; I am covering sickness on the nursing rota in the cardiac ICU.
What I’ve learned shadowing ICU nurses on 12-hour shifts
I am far from being a qualified ICU nurse. I have some distant experience as a registrar coming into our ICU, but after 2012, I stopped spending any time here – so how did I get the training to do this?
On 19 March I paired up with the senior nurse trainer in our ICU for a 12-hour shift and basically did exactly what he said.
I watched the routine, including taking blood gases, drawing up of propofol and fentanyl, four-hourly turning of the patient, mouth care, giving of medications via the nasogastric (NG) tube and, of course, how to look after the ventilator and endotracheal tube (ET).
I was more hinderance than help that day, as I’m sure my trainer Jim will agree.
‘I am still learning and I will never be as competent as our full-time ICU nurses, but I now feel equipped to put in a shift without disturbing staff too much with questions’
On 23 March, I did another 12-hour shift with a second trainer. This time I felt much more confident and would say I could do 60% of the work required to look after the ventilated patient safely, although I will admit to wrecking the chart with a few bad mistakes.
I stopped being supernumerary and became part of the full nursing complement, our ICU maintaining its one-to-one nurse-to-patient ratio. Jim was looking after the patient next to me and it went well.
Then I did a fully independent shift, looking after a ventilated patient on continuous positive airway pressure with pressure support who was starting to wean, and I felt that went well too.
Tonight will be my third nursing shift. They need a 12-hour night shift as some nurses in our normal complement are off due to coronavirus, and I am doing a week of nights next week.
Redeploying and training staff to care for ventilated patients
The trust is planning to increase our provision of ventilated beds. Our ICU nursing team is working round the clock to create a ‘reserve army’ of people who can be mobilised to look after these ventilated patients safely.
Our ICU team is now providing daily training for theatre nurses, operating department practitioners and other nurses from a non-ICU background. This support includes lecture-based training and pairing up with ICU nurses on shifts.
Everyone is welcome, especially clinicians of all types whose own activities are quieter than usual due to the suspension of elective activity.
The NHS is mobilising an NHS ‘reservist army’ to keep us all safe at this difficult time. Very proud to be part of this great NHS. pic.twitter.com/q0Gx2bl84Y— Surgeon turned Nurse - Joel Dunning (@joeldunning) March 31, 2020
It has been my absolute pleasure to be welcomed into the ICU as warmly as I have. I am still learning and I will never be as competent as our ICU nurses, but I now feel equipped to put in a shift without disturbing our full-time staff too much with questions.
A full-time job caring for one patient
I have learned how hard a job ICU nursing is and the huge range of care these nurses give to keep a long-term ventilated patient safe.
From four-hourly rolling, patient hygiene, mouth care, nutrition, line care and pressure testing of the ET cuff to blood gas management and safe intravenous and NG medication administration, it is a full-time job to look after one ventilated patient.
It will be a big challenge to maintain the one-to-one nurse ratio during the COVID-19 crisis. I hope that with the support of the team of ‘reservists’ of which I am a part, we can keep each patient as safe as if they were being cared for in normal times.
Well done to everyone who is stepping up to the mark in the NHS at this difficult time.
Joel Dunning is a consultant thoracic surgeon at South Tees Hospitals NHS Foundation Trust