Staffing intensive care units: a consideration of contemporary issues (original) (raw)
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Nurse staffing, medical staffing and mortality in Intensive Care: An observational study
International journal of nursing studies, 2014
To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital m...
Nurse staffing and patient outcomes in critical care: A concise review
Critical Care Medicine, 2010
A t the conclusion of this CME activity, participants should be able to measure nurse staffing ratios in their intensive care unit (ICU) and use this information to improve patient outcomes. Determining the right number and characteristics of nurses needed to meet patient needs has been a topic of interest because of limited resources, financial constraints, and the nursing shortage. California was the first state in the United States to mandate nurse-to-patient-ratios in 2004, and other states are considering adopting similar mandates. California's mandates for staffing were over a variety of hospital nursing settings. However, results from a study 2 yrs after regulation in California indicated that although this mandate did result in an increased licensed nurse staffing, an improvement in patient outcomes was not found in medical-surgical and step-down units. The anticipated decreases in two key nursing-sensitive outcomes, falls or prevalence of hospital-Background: Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Most of those studies were generated from general acute care units. Critically ill patients demand increased nurse staffing resources and nurses who have specialized knowledge and skills. Appropriate nurse staffing in critical care units may improve the quality of care of critically ill patients. Objectives: To review the literature evaluating the association of nurse staffing with patient outcomes in critical care units and populations. Methods: An annotated review of major nursing and medical literature from 1998 to 2008 was performed to find research studies conducted in intensive care units or critical care populations where nurse staffing and patient outcomes were addressed. Results: Twenty-six studies met inclusion for this review. Most were observational studies in which outcomes were retrieved from existing large databases. There was variation in the measurement of nurse staffing and outcomes. Outcomes most frequently studied were infections, mortality, postoperative complications, and unplanned extubation. Most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care unit patients. Conclusions: Findings from this review demonstrate an association of nurse staffing in the intensive care unit with patient outcomes and are consistent with findings in studies of the general acute care population. A better understanding of nurse staffing needs for intensive care unit patients is important to key stakeholders when making decisions about provision of nurse resources. Additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units. (Crit Care Med 2010; 38:1521-1528) KEY WORDS: nursing staff; hospital; outcome and process assessment; intensive care unit; critical care; personnel staffing and scheduling; hospital mortality; postoperative complications; nursing workload LEARNING OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Measure nurse staffing ratios. 2. Evaluate impact of nurse staffing in intensive care unit on intensive care unit outcomes.
Workforce dilemmas:a comparison of staffing in a generalist and a specialist intensive care unit
Intensive and Critical Care Nursing, 1999
Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.
Nursing Staff in Intensive Care in Europe
CHEST Journal, 1998
Objective: To test the use of a human resources-based classification of levels of care of ICUs; to evaluate the match between planned vs operative levels of care on a large sample of European ICUs. Design: Analysis of the database of a multicentric, multinational, prospective cohort study, involving 89 ICUs from 13 European areas. Setting: Database of EURICUS-I. Methods: Provision ofresources was measured as the number ofnurses per ICU bed. Use ofresources was measured by the daily use ofa therapeutic index (nine equivalents of nursing manpower use score, NEMS) at patient level. Work utilization ratio (WUR) indicated the total number of NEMS points actually scored divided by the total possible NEMS score on each ICU. The planned level of care (LOC) or the mean number of patients to be assisted by one nurse (P/N ratio) made available to the unit was derived from the number of nurses and the number of beds in the ICU. The operative LOC or the actual mean number of patients who were assisted by one nurse (P/N ratio) was computed by dividing the number of NEMS points equivalent to the work of three nursing-shifts (46 points) by the mean daily NEMS score at ICU level. Severity of illness was evaluated by the new simplified acute physiology score. Kappa statistics, intraclass correlation coefficients, and interrater percentage of agreement were used to evaluate the reliability of the data collected for total NEMS score. \2 statistics and one-way analysis of variance were used when appropriate. Main results: Data of 16,047 patients (74,383 patient-days) admitted to the ICUs were analyzed. With an overall value of 26.5 ±9.3, the mean NEMS score at ICU level varied significantly among European areas. These differences were not explained by the severity of illness of the patients. The mean WUR was 0.73 ±0.29, presenting also significant differences among ICUs and European areas that were not explained by severity of illness. There was a mismatch between planned vs operative LOCs on 68 ICUs (76%); on 65 (73%), the operative LOC was lower than the planned LOC. This loss of resources concerned particularly the 61 ICUs planned to operate at LOC 3. Conclusions: The use of human resources-based classification of LOCs is an objective method for evaluation of the match between provision and use of resources in the ICU. This study has shown a large mismatch between planned and utilized LOC in a sample of 89 European ICUs. This mismatch, suggesting an important loss ofinvested resources, was more apparent in the ICUs that were planned to operate at a higher level of care. (CHEST 1998; 113:752-58) Key words: critical care; intensive care; levels of care; nursing workload; resources Abbreviations: LOC=levels of care; LOS=length of stay; NEMS=nine equivalents of nursing manpower use score; P/N=patient/nurse; SAPS=simplified acute physiology score; TISS=therapeutic intervention scoring system; WUR=work utilization ratio Proposed initially by Lockward et al1 in 1960, the concept of levels of care (LOC) was defined the first time by a National
Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units
Journal of Clinical Nursing, 2009
Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes.Background. Nurse staffing has been reported to influence patient and nurse outcomes.Design. A cross-sectional study with a survey conducted August–October 2007.Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes.Results. The average patient-to-nurse ratio was 2·8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3·26; 95% confidence interval, 1·14–9·31) or 2·0–2·5 patients (odds ratio, 2·44; 95% confidence interval, 1·32–4·52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2·97; 95% confidence interval, 2·22–3·97) in the odds of nurses’ rating high quality and decreases in the odds of dissatisfaction (odds ratio, 0·30; 95% confidence interval, 0·23–0·40), burnout (odds ratio, 0·50; 95% confidence interval, 0·34–0·73) and plan to leave (odds ratio, 0·40; 95% confidence interval, 0·28–0·56).Conclusions. Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units.Relevance to clinical practice. Adequate staffing must be assured to achieve better quality of care and job outcomes.
Nurse Staffing and Patient Mortality in Intensive Care Units
Nursing Research, 2008
Background: Research evidence suggests that nurse staffing influences patient outcomes. b Objectives: To examine the relationship between nurse staffing and patient mortality in Korean intensive care units (ICUs). b Methods: Using survey and administrative databases, this study included 27,372 ICU patients discharged from 42 tertiary and 194 secondary hospitals. Ownership (public vs. private), location (metropolitan city vs. province), size, specialization of ICUs (specialized vs. mixed), physician staffing and nurse staffing, and years of nurse experience were included as hospital and ICU characteristics. Nurse staffing was measured as the ratio of average daily census to the total number of full-time equivalent registered nurses in ICUs. Age, gender, 26 categories of primary diagnoses, 16 groups of comorbid conditions, and source of payment were used for risk adjustment. Mortality was defined as deaths that occurred in the hospital or on the date of hospital discharge. Using SAS GLIMMIX procedures, multivariate logistic regression analysis was employed separately for tertiary and secondary hospitals. b Results: In tertiary hospitals, a greater likelihood of dying was 322
Nurse staffing models in acute care: A descriptive study
Nursing Open, 2019
Staffing is a cornerstone of human resource management. The performance of any healthcare organization depends primarily on the continuous availability of enough qualified workers, judiciously deployed and operating in a work environment that enhances their productivity. Studies showed the importance of adequate staffing for optimizing both patient outcomes and the quality and security of care. In many industrialized countries, healthcare systems are facing a rising demand for hospital care (Australian Institute of Health &
Physician staffing pattern in intensive care units: Have we cracked the code?
World Journal of Critical Care Medicine, 2012
Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units (ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multidisciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffing may be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.
Nursing protects, promotes and optimizes health and capacity, prevents illness and injury, promotes healing, diagnoses and treats human responses to alleviate suffering, and advocates for the care of individuals, families, groups, communities and the communities. One of the most often studied aspects among the quality patient care are nursing workload, nurse patient ratio, nurse's availability in the intensive care unit, which directly has an impact on the efficacy of quality patient care. The purpose of this study is to assess the Nurse Patient Ratio as per the statutory requirements. To advocate the availability of Nursing Staff in the ICU's. To study the workload of all the staff nurses in the ICU's & calculating nursing staff requirements' Descriptive research is used. It is carried out in SICU, MICU, CCU and ITU. The number of patients in the observational study was 206 and the number of nurses was 24. Data collection is carried on needed legal requirements. Data were tabulated and percentile score were calculated. Results demonstrated the need for refining of stature patient-nurse ratio, nursing workload and nursing availability in ICU. The study was useful in drawing out the limitations which would pave a way for improved planning.