In the second half of March, Teton County’s number of lab-confirmed cases of COVID-19 was still in the single digits, but administrators at St. John’s Health worried the number could spike, overwhelming hospital staff and facilities.
Hospitals have a certain amount of surge capacity, the ability to handle an influx of patients. Since humans have no natural immunity, the coronavirus outbreak threatened to eclipse the hospital’s capacity.
Acting fast, the hospital leaned on the St. John’s Health Foundation to buy ventilators, personal protective equipment and other supplies. To run the facility should critical care needs escalate or if employees were hit hard by the virus and couldn’t work, St. John’s turned inward, creating a nurse retraining program that started at the end of March.
“We looked through our entire staff, over 250 nurses, and went through their history and experiences,” Chief Nursing Officer Marsha Sensat said. “We looked to see if we could pull them back into critical care.”
Heading into the training program, St. John’s had about 20 nurses in the ICU and roughly double that number in the emergency department, Clinical Education Manager Elizabeth Whitaker said. A surge of ventilated patients could have easily left the hospital short-staffed or made those nurses work around the clock.
Several nurses are needed for intubation, the process of putting the breathing tube into a patient, and to monitor ventilated patients. Scientific American reported that most COVID patients who were put on ventilators needed them for one to three weeks, much longer than patients who need breathing support for most other conditions.
In addition to the potential for high staffing needs, adequately trained frontline employees might find themselves unable to work during an outbreak.
“Healthcare workers play key roles during an influenza pandemic, but a serious shortage of personnel may occur at peak times or in severe pandemics because of absenteeism due to illness, caring for family members who are ill, or refusal to work,” states a 2015 literature review in the Influenza and other Respiratory Viruses journal.
Sensat and Whitaker initially identified 84 nurses with previous experience. Using free modules from Healthstream, a company that creates online health care training programs, and some internal materials, they devised a 21-hour online program that touched on personal protective equipment, ventilator use and other elements of critical care.
Usually Healthstream programs cost money, but the company made its COVID programming free to any hospital or health care system, giving St. John’s an opportunity it may not have otherwise had. Once nurses completed the online portion they did hands-on training with critical-care nurses and spent a few shifts in the intensive care unit or emergency department.
Given the speed of the outbreak in places like New York, Whitaker and Sensat saw a need to move quickly. Teton County had several weeks more to prepare than other places, which made a huge difference. Without the extra time, Whitaker said, the hospital would have struggled to train its staff before they were needed on the floor.
A couple of other things helped St. John’s create the program, factors that could be tough to replicate. First, the hospital had a bevy of nurses with past critical-care experience, which was necessary because those skills can’t be taught overnight.
“We were not going to make a critical care nurse in 21 hours of training and a couple of floor shifts,” Whitaker said.
Second, because of the pandemic, elective procedures were canceled, which allowed the nurses, who work in departments throughout the hospital, the time to train. If another hospital wanted to begin a similar retraining program, it would likely take more time or force nurses to work overtime under normal operations.
With the pandemic still happening, it can be difficult to quantitatively determine the success of programs like the one at St. John’s. One measure Whitaker used was simply the number of available critical-care nurses. As of Monday, 44 nurses had been retrained, greatly bolstering the ranks, and seven more were ready to do hands-on training if necessary.
In looking at a previous pandemic, the 2009 H1N1 outbreak, administrators at Mount Sinai Hospital in New York City found they could reduce absenteeism and maintain better staffing by increasing resilience through education programs. Mount Sinai’s evidence is anecdotal, but it did show education was a key factor that increased staff feelings of preparedness and decreased burnout during the pandemic surge.
With the 44 nurses retrained, Whitaker said St. John’s feels prepared. The potential surge has not come, at least not at the scale seen elsewhere, and with new case numbers declining Whitaker is cautiously hopeful.
“We’re in a good place, census wise,” she said.
Being overprepared was more desirable than not being ready. Whether the retrained nurses are needed or not, Whitaker said she appreciates that they are equipped to jump in should cases spike or a second wave of infections hit.
“The collaboration and having people willing to help has been incredible to watch,” she said. “Next on the education and training plan is figuring out how we keep engaging them.”