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Nurses will be able to care for two critically ill patients with Covid-19 at the same time after NHS leaders loosened the rule that requires individual treatment in intensive care as hospitals are under severe strain.
NHS England has decided to temporarily suspend the 1: 1 rule as the number of people who are very sick with Covid in the hospital has risen to 11,514, of which 986 are on a ventilator.
The move comes amid concerns that intensive care units, which have entered the pandemic already short of nurses, are being hit by sick or isolated staff due to Covid.
There follows a warning last week from England’s chief medical officer Prof Chris Whitty that the resurgence of Covid could overwhelm the NHS.
Dr Alison Pittard, Dean of the ICU Faculty, who represents doctors in ICUs, welcomed the move to a more “flexible” nurse / patient relationship in ICU. But he warned it should only be used as long as the second wave puts the units under heavy pressure.
“Covid has placed the NHS, and especially critical care, in an unenviable position and we must admit all those for whom the benefits of critical care outweigh the burden. This means loosening normal staffing relationships to meet this demand in a way that provides safe care, but also taking into account the impact this can have on staff health and well-being.
“The 1: 2 ratio is a maximum ratio, to be used only to support Covid activity, [and] not for planned care and is not sustainable in the long term. This protects staff and patients, “he said.
NHS England has agreed relaxation with the British Association of Critical Care Nurses, which represents specialist nurses working in high addiction and ICU units. They will have to confirm the deal in a formal announcement soon.
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Whitty used an interview last week with the British Medical Journal to warn that the combination of Covid and the usual increase in cold-season illness will bring “an extremely difficult winter for the NHS – one which I suspect, unfortunately, will be unlike any other. seen in recent memory. “
One of the ways Covid can lead to death is through “overloading the emergency services so that all emergency care stops. Fortunately we avoided it in the first wave, but it’s not a fact if we don’t act forcefully. “
The NHS-wide lack of critical care nurses was a key factor in the 1: 2 decision, Pittard added.
“The [revised] Guidance is needed because we don’t have enough ICU staff to support the increase in the number of beds needed to care for all patients with Covid and those with other conditions in need of hospitalization.
“There is [also ongoing Covid-related] disease that worsens the current situation, but the main problem is the long-standing inability to expand the workforce, namely doctors, nurses and allied health professionals, “he added.
The new 1: 2 ratio is much better than NHS England’s decision in the spring to allow critical care nurses to care for up to six Covid patients if patient numbers require it. However, despite that change, no nurses are thought to have cared for more than four patients in the first peak.
Susan Masters, Director of Nursing, Policy and Public Affairs at the Royal College of Nursing, said, Reducing the ratio of nurses to patients should be a temporary measure and only when absolutely necessary. We must ensure the safety of patients and at the same time protect the well-being of the nurses who care for them.
“This change means increasing the workload of intensive care nurses and there must be consideration of the physical and emotional cost that this will require.”
NHS England declined to comment directly on the change in guidance.
A spokesperson said only that: “The NHS has 13,000 more full-time equivalent nurses than us last year and record numbers signed up to start nursing degrees this fall.
“However, with Covid-19 infections on the rise both here and across Europe, Medical Royal Colleges and professional associations have made it clear that just as they did during the first wave of Covid, doctors, nurses and other healthcare professionals will obviously treat. everyone who needs critical care. “
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