ACCCN national nursing workforce survey of intensive care units

Quality of practice in an intensive care unit (ICU): a mini-ethnographic case study

BACKGROUND

Nurses' perspectives of maintaining quality practice is important in the context of today's safety and quality agenda. This study provides a snapshot of registered nurses' perspectives on practice quality in one Australian ICU.

METHODS

A mini-ethnographic case study examined how quality is embedded in the culture of ICU nursing. Semi-structured interviews of 10 informants were analysed using Spradley's (Spradley JP. The ethnographic interview. Sydney: Holt, Rinehart and Winston, Inc.;1979) ethnographic guidelines.

FINDINGS

Three major themes influenced nursing quality: maintaining cohesiveness in a complex and stressful environment; rapid, effective and respectful communication; and specialist knowledge gained through experience and formal learning.

CONCLUSION

The nurses reported satisfaction with the quality of their ICU practice, but revealed factors that could diminish quality and contribute to job dissatisfaction. Given current recruitment and retention issues and the link between satisfaction and retention, it is important to consider this these factors in advancing the knowledge base for workforce planning.

An irreplaceable safety culture

Intensive care unit (ICU) clinicians are sources of errors and of resilience. When they learn how to juggle many competing goals, remain vigilant, and tell safety stories--all in the context of changing technologies and demand--they can create safe settings of care. Other strategies (eg, using computerized tools and implementing safety procedures) are important, but alone they are not sufficient. An ICU needs a safety culture that is rooted in a committed leadership, the acknowledgment that error is inevitable, a reporting system, and continuous learning. The all too common norm, "no harm no foul," is an obstacle. ICU leaders can use a campaign strategy to spread the safety practices that sustain a safety culture. They should attend to the political, marketing, and military aspects of such campaigns and recognize that people's time and attention are limited and built projects from existing ongoing pilots. Pilots can compete for people's attention; it has pull when it exemplifies a moral idea, simplifies work, and gives the health care professional more control and feedback. Under these conditions, the campaign will release individuals' passions and add energy and insight to the campaign itself.

What makes a good intensive care unit: a nursing perspective

With the high prevalence of nursing shortages and low staff retention rates in many Australian intensive care units (ICUs), we aimed to determine what factors were important to nurses working in an ICU. Of all the nursing specialties in New South Wales, intensive care was reported to have had the fifth highest vacancy rate from June 2000-January 2001. A questionnaire was distributed to 36 nurses in a major metropolitan ICU. The response rate was 32 (89 per cent). The ICU has had high staff retention rates and low vacancy rates for a number of years. We were interested to document what factors made this unit a popular one to work in. Factors that were of greatest importance to most nurses were those that dealt with nursing unit management and medical staff. Other factors that rated highly included the ability to self-roster, some aspects of working relationships and having an active role in patient care issues. The survey informed us that nurses at this study site were mostly satisfied with these aspects. Previous studies have demonstrated a strong correlation between job satisfaction and turnover rates amongst nurses. The results of this study highlight the importance of good nursing management and various aspects of the nursing role in attaining job satisfaction in the workplace. These key factors play an important role in achieving high staff retention and low vacancy rates.