The View from the ICU

Managing the influx of patients during COVID-19 surges was possible only with exceptional teamwork in the ICU.

When the first COVID wave hit, Laurie Freed, BSN, RN, CCRN-CSC, an ICU/CCU nurse, felt incredible sadness for her patients who required intensive care.

“These patients were the unlucky ones, in the wrong place at the wrong time when they got exposed to the virus,” Freed says. “Some people did everything right and they still became severely ill and sometimes passed away from the effects and complications of the virus. It seemed so unfair.”

Freed was overwhelmed with emotion when vaccines became available because she had seen so many patients succumb to the virus in the winter of 2020-21.

“I just knew these vaccines would put a stop to it. However, with the introduction of the vaccines came the vaccine hesitancy and the anti-vax movement, and my sadness for these patients turned to anger and frustration,” Freed admits.

Nurses and other medical staff also frequently dealt with misinformation about COVID and its treatments. While in many cases, interactions with families involved offering support through their loved ones’ illnesses and sympathy for their grief, other interactions were more stressful. Freed and her colleagues had to remain calm and reasonable as some family members of patients refused to believe in the existence of the virus, demanded ineffective treatments like ivermectin, and even lashed out with insults.

Showing Remarkable Strength

Managing the influx of patients during surges was possible only with exceptional teamwork, she says.

“Our core staff worked extra shifts or extended shifts of 16 hours, back-to-back, to piece together coverage so patient ratios would remain safe,” Freed says. “It takes four nurses and a respiratory therapist to safely prone a patient, and at the height of the pandemic, we could be proning and supinating multiple patients several times a day.”

Proning means to place a patient on their stomach, and supinating means to return them to lying on their back.

Despite their exhaustion, Freed says her colleagues regularly went above and beyond for their patients.

“Every time one dying patient’s heart rate fell, I saw one of our nurses – Jean Marll, BSN, RN, CCRN – don her PPE gear and go into their room to hold their hand in case they were in their final moments. This happened several times an hour. She went in each time to make sure the patient was not alone when they died, no matter how busy she was,” Freed says.

Medical staff also learned a lot throughout the pandemic, developing new evidence-based practices. Nurses, respiratory therapists and wound care specialists worked together to create a protocol for proning – previously a rarely used treatment technique – that made positioning the patient easier and prevented pressure injuries.

“Proning can change how different parts of the lungs are ventilated, which can improve a patient’s oxygenation state,” Freed says. We are now proning non-COVID patients who have other types of complicated pneumonias earlier and more often and seeing improved outcomes.”

Freed says she would especially like to highlight the strength of the 5 Tower Telemetry nurses. As the first unit to receive COVID patients, they completely changed the way they practiced and taught all of the ICU nurses how to safely put on and take off PPE.

“These nurses all previously worked on a specialized stroke unit, caring for and rehabbing patients who were expected to get better,” Freed says. “They had to quickly shift into a respiratory care unit, where their patients would often be sick for a long time and ultimately pass away. These nurses were not used to the amount of death they would see. I observed many instances where a nurse would become emotional and nurses from her unit as well as our ICU nurses would come and provide comfort, a shoulder to cry on, words of assurance that they did everything they could for the patient or that the patient wasn’t alone because of them.”

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