To examine the organisation of the nursing workforce in intensive care units and identify factors that influence how the workforce operates.
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.
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.
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.
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.
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.
2019年12月至2020年7月期间，在英格兰与重症监护医护人员进行焦点小组讨论（n = 52名参与者），与重症监护网络负责人和政策负责人进行个别访谈（n = 14名参与者）。采用框架分析法对数据进行分析。
为了保障病人和工作人员的安全，在人员配置决策中需要考虑诸如ICU的布局等因素，并且当地的护士配置的商业案例需要反映这些因素。重症监护室的病人安全可能不适合用一揽子 "比率 "的方法来配置护士，因为这种方法旨在统一适用于所有医疗服务。
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