Skip to Main Content

Stepdown Units Trained to Care for ICU Patients

Exemplary Professional Practice

The University of Miami distributed its first health advisory addressing the emerging COVID-19 pandemic at the end of January 2020. There was uncertainty within the hospital community about how the outbreak in Wuhan, China might impact the UHealth Intensive Care Unit’s (ICU) census and acuity. Realizing that the number of patients needing ICU-level care might increase dramatically, unit leadership and clinical nurses met to creatively prepare and strategize for a surge of acutely ill patients with COVID-19.

In early March 2020, as the first patient diagnosed with COVID-19 was admitted to the UHealth Tower, increasing the number of nursing staff trained to care for ICU patients and creating additional ICU beds became essential. The nurses on the stepdown unit were motivated to support their ICU colleagues and the ICU’s rising patient census, so cross training the stepdown nurses to care for more seriously ill patients was initiated. With the support of nursing leadership and the commitment of the ICU and stepdown unit nurses, coordination and collaboration among the teams brought the plan to successful execution. “There was nothing but great support and willingness from our staff. I have never seen our nurses more eager and willing to fully engage in the complex care of extremely ill patients,” stated Julio Garcia, BSN, RN, Director of Nursing, Acute Care Services. Morning huddles were initiated to assure optimal communication and Unit-Based Practice Council meetings focused on the complex plans of care for the increasing numbers of very ill patients.

Based on the positive response from the staff, the ICU accommodated two to four stepdown unit nurses at a time in two-week intervals to offer a comprehensive orientation. Each nurse received focused training to develop the clinical knowledge and critical thinking skills necessary to care for ICU patients. As with all new nurses to the ICU, the cross-trained nurses would have been assigned to care for the more stable patients so that their ICU colleagues would be available to care for the more acutely ill and complex patients with COVID-19. Though the focus of the education in the ICU was on nursing care, the effort was inherently interdisciplinary. For example, the nurses’ colleagues in the pharmacy were pivotal in educating regarding which intravenous medications could be safely administered outside the ICU environment.

The partnership between stepdown nurses and ICU nurses was extraordinary. The initiative's success was only possible because of both units’ commitment and the steadfast support of nursing leadership. Everyone involved demonstrated courage, engagement, and a willingness to support the organization's efforts in the era of COVID-19. As Garcia noted: UHealth is our cohesive team and committed to making the Nursing Professional Practice Model come alive in the stepdown and ICU areas.”