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The organisation of nurse staffing in intensive care units: a qualitative study

The organisation of nurse staffing in intensive care units: a qualitative study
The organisation of nurse staffing in intensive care units: a qualitative study
Aims
To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates.

Background
Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence.

Methods
Focus groups with intensive care health care professionals (n = 52 participants) and individual interviews with critical care network leads and policy leads (n = 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis.

Findings
Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes.

Conclusions
Whilst nurse:patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff well-being, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies.

Implications for Nursing Management
In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket ‘ratio’ approach to nurse staffing, intended to apply uniformly across health services.
intensive care unit, staffing levels, workforce, workload management
0966-0429
1283-1294
Endacott, Ruth
f50a0a28-b482-40da-9a01-89652eecfcfa
Pattison, Natalie
f4d061c6-edd9-4296-af5a-d62dbdfbfd3b
Dall’ora, Chiara
efdca45d-9cdd-4371-8774-e6f04a907f30
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Richardson, Annette
4b3040e2-3e12-4ca9-a98e-8d77a5b45ff9
Pearce, Susie
efc04ece-af26-452f-9e81-c610ded64b8d
Endacott, Ruth
f50a0a28-b482-40da-9a01-89652eecfcfa
Pattison, Natalie
f4d061c6-edd9-4296-af5a-d62dbdfbfd3b
Dall’ora, Chiara
efdca45d-9cdd-4371-8774-e6f04a907f30
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Richardson, Annette
4b3040e2-3e12-4ca9-a98e-8d77a5b45ff9
Pearce, Susie
efc04ece-af26-452f-9e81-c610ded64b8d

Endacott, Ruth, Pattison, Natalie, Dall’ora, Chiara, Griffiths, Peter, Richardson, Annette and Pearce, Susie (2022) The organisation of nurse staffing in intensive care units: a qualitative study. Journal of Nursing Management, 30 (5), 1283-1294. (doi:10.1111/jonm.13611).

Record type: Article

Abstract

Aims
To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates.

Background
Pre-pandemic UK survey data show that up to 60% of intensive care units did not meet locally agreed staffing numbers and 40% of ICUs were closing beds at least once a week because of workforce shortages, specifically nursing. Nurse staffing in intensive care is based on the assumption that sicker patients need more nursing resource than those recovering from critical illness. These standards are based on historical working, and expert professional consensus, deemed the weakest form of evidence.

Methods
Focus groups with intensive care health care professionals (n = 52 participants) and individual interviews with critical care network leads and policy leads (n = 14 participants) in England between December 2019 and July 2020. Data were analysed using framework analysis.

Findings
Three themes were identified: the constraining or enabling nature of intensive care and hospital structures; whole team processes to mitigate nurse staffing shortfalls; and the impact of nurse staffing on patient, staff and intensive care flow outcomes. Staff made decisions about staffing throughout a shift and were influenced by a combination of factors illuminated in the three themes.

Conclusions
Whilst nurse:patient ratios were clearly used to set the nursing establishment, it was clear that rostering and allocation/re-allocation during a shift took into account many other factors, such as patient and family nursing needs, staff well-being, intensive care layout and the experience, and availability, of other members of the multi-professional team. This has important implications for future planning for intensive care nurse staffing and highlights important factors to be accounted for in future research studies.

Implications for Nursing Management
In order to safeguard patient and staff safety, factors such as the ICU layout need to be considered in staffing decisions and the local business case for nurse staffing needs to reflect these factors. Patient safety in intensive care may not be best served by a blanket ‘ratio’ approach to nurse staffing, intended to apply uniformly across health services.

Text
The organisation of nurse staffing in intensive care units - Accepted Manuscript
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More information

Accepted/In Press date: 23 March 2022
e-pub ahead of print date: 10 April 2022
Published date: July 2022
Additional Information: Funding Information: This paper presents independent research funded by the National Institute for Health Research (Programme Development Grants, Safe staffing in ICU: development and testing of a staffing model, NIHR200100). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care, neither of whom have had involvement in any aspect of the design, data collection, synthesis, interpretation or writing of, this paper. Publisher Copyright: © 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.
Keywords: intensive care unit, staffing levels, workforce, workload management

Identifiers

Local EPrints ID: 456578
URI: http://eprints.soton.ac.uk/id/eprint/456578
ISSN: 0966-0429
PURE UUID: 0c665324-9732-4ed8-bece-148c32fb67a2
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 05 May 2022 16:39
Last modified: 26 Nov 2022 02:44

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Contributors

Author: Ruth Endacott
Author: Natalie Pattison
Author: Chiara Dall’ora
Author: Peter Griffiths ORCID iD
Author: Annette Richardson
Author: Susie Pearce

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