4.2 nurse staff allocation and support
According to the requirements of Nosocomial Infection Prevention and Control[3], the ICU should be equipped with a sufficient number of professional medical staff. At that time, there were 138 nursing staff, including 135 nurses and 3 head nurses, in charge of 36 beds. The ratio of the number of nurses to the actual number of beds was 3.8:1. We adopted a 4-hour shift model. That is, they worked 4 hours a day for 6 consecutive days and took a day off after six working days. The psychological counseling hotline in the mental hospital was open 24 hours a day. Staff could call it for free whenever they need to.
There are 18 primary nurses on duty during each shift. On average, one nurse is in charge of two critically ill patients. Two additional nurses are specialized in dealing with medical orders, informing corresponding primary nurses, admitting patients, documenting critical values from the clinical laboratory, replenishing supplies and rescue drugs, checking accounts and discharging patients. One nurse is responsible for the preparation of medicines for all patients in the ward and the replenishment of commonly used medicine. The persons from the infection control department hold the supervising position, whose job responsibility includes checking and ensuring that all personnel wear protective equipment appropriately when entering the ward, supplying consumable items and clearing the semi-polluted area. One addtional position was for staff catering, transportation and accommodation.
We set a lead nurse on each shift, who had the responsibilities of managing, inspecting, supervising, guiding, and assigning patients to each primary nurse. Each team consisted of nurses with ICU backgrounds and non-ICU backgrounds. The combination of different working years was another consideration.
Running Effect
From 4/2/2020 to3/4/2020, the wards have been running for 59 days. A total of 172 critically ill patients with COVID-19 were admitted to the temporary ICUs. Oxygen therapy is a key component of treatment for patients with COVID-19 and mechanical ventilation was commonly used in the critical ill. We had 126 patients who received invasive mechanical ventilation and 68 patients who received noninvasive ventilation during hospitalization. Fiberoptic bronchoscopy examination, as a high-risk procedure, was also performed 43 times for diagnosis and treatment. To protect the involved staff in this procedure, we developed a revised standards for this procedure, including detailed preparation prior to exam, precaution strategies and decontamination of bronchoscope and environment. ECMO therapy is the last resort for maintaining critical patients’ respiratory and cardiac function. Six patients had undergone this treatment in our unit. Additionally, 281 CRRTs and 15 tracheotomies were successfully carried out at the patients’ bedsides. In spite of the heavy workload and high-risk working environment, none of the staff were infected or had any mental health problems, fortunately.
Acknowledgment: The work is supported by the Nature Science Foundation of Hubei Province [No.2019CFB645] for language editing.
Conflicts of interest : None.
References
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