Brittany Baptise is a nurse at the Scarborough General Hospital in Trinidad and Tobago, in the Caribbean. Today is her day off and she smiles as she describes how nervous she was when she learned that she would be working in an intensive care unit (ICU) to treat COVID-19 patients.
“I was a bit fearful because, coming from the medical ward, we didn’t really know the rules and function of an ICU. I had no formal training, I had little knowledge about how the ventilator works, the settings and these things.”
By the end of September 2020, Brittany was trained and working in the ICU with new skills and competencies to offer as part of an integrated team of health professionals. She was one of a cadre of 82 nurses across 7 Caribbean countries to take part in a 4-week training course to learn new skills and competencies to work in ICUs. These nurses are now making significant contributions to hospitals across the Caribbean providing critical care to COVID-19 patients.
This is crucial to the achievement of universal health coverage (UHC), which is dependent on a sufficient, equitably distributed and well-performing health workforce. The arrival of COVID-19 has severely challenged progress in this area.
Urgent need for critical care nurses during the COVID-19 pandemic
In March 2020, the Caribbean Region recorded its first imported case of COVID-19. By mid-March 2021, there had been more than 100,000 confirmed cases, and some 2,000 deaths across 20 countries in the Caribbean. The pandemic exposed a range of weaknesses in country health systems and the health workforce; a key problem being a shortage of critical care nurses.
Recognizing the urgent need, the University of West Indies School of Nursing, a PAHO/WHO Collaborating Centre for Nursing and Midwifery, developed a course to equip nurses with the right skills and competencies to provide critical nursing care in ICUs.
The PAHO/WHO Trinidad and Tobago Country Office supported the training of 2 cohorts of a total of 50 nurses from the Ministry of Health of Trinidad and Tobago. The PAHO Subregional Programme for the Caribbean, through the UHC Partnership, supported an additional cohort of 32 nurses from 6 other countries of the Caribbean: Antigua and Barbuda, Belize, Barbados, Dominica, Guyana and Suriname.
The UHC Partnership works in 115 countries and areas to help governments accelerate progress towards UHC with a primary health care approach, through funding provided by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, and the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.
Critical care training in theory and practice
The 4-week training was a combination of virtual sessions with face-to-face training in a clinical setting. The course covered clinical care for COVID-19 patients; foundations of critical care; management of respiratory conditions; renal dysfunction and replacement theory; epidemiology and infection control; management of neurological conditions; and the Critical Care Practicum.
In each hospital, the Ministry of Health identified a member of staff who acted as preceptor and provided mentoring and clinical supervision to the student nurses.
Nurses who have been trained are able to think critically about their work in the ICU, are no longer intimidated by the ward environment and equipment, are able to better assess patients and communicate more effectively with patients and colleagues.
From a health systems perspective, the nurses have gained new skills, which they can transfer to general wards, and their additional capacities can facilitate task sharing and task shifting as an alternative to shortages of health care workers during the pandemic.
This critical care training will also have an impact beyond the ICUs and contribute to a stronger health system overall throughout the Caribbean.
WHO has declared 2021 as the International Year of Health and Care Workers in recognition of their dedication to providing care during the COVID-19 pandemic that has challenged health systems worldwide.