1. Workforce management and patient outcomes in the intensive care unit during the COVID‐19 pandemic and beyond: a discursive paper
- Author
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Caleb Ferguson, Patricia M. Davidson, Debra Jackson, Christine Duffield, and Rochelle Wynne
- Subjects
medicine.medical_specialty ,workforce ,nurse staffing ,1110 Nursing ,Workforce management ,Nursing ,Special Issue Discursive Paper ,intensive care unit ,law.invention ,1117 Public Health and Health Services ,03 medical and health sciences ,0302 clinical medicine ,law ,COVID‐19 ,Intensive care ,Critical care nursing ,Acute care ,Health care ,medicine ,030212 general & internal medicine ,Intensive care medicine ,General Nursing ,11 Medical and Health Sciences ,030504 nursing ,business.industry ,COVID-19 ,1103 Clinical Sciences ,General Medicine ,Intensive care unit ,mortality ,Coronavirus ,critical care ,Skill mix ,Workforce ,Special Issue Discursive Papers ,1110 Nursing, 1117 Public Health and Health Services, 1701 Psychology ,0305 other medical science ,business - Abstract
AimsTo highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.BackgroundIn acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.DesignDiscursive paper.FindingsNursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.ConclusionCOVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.Relevance to clinical practiceObjective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.
- Published
- 2021