The true worth of a nurse … time to act!

The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia

Objective

This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient's stay.

Design

Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.

Settings

Fifteen public and 5 private hospital ICUs in Victoria, Australia.

Participants

There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.

Main outcome measures

Primary outcome: in-hospital mortality. Secondary outcomes: in-ICU mortality, development of delirium, pressure injury, duration of stay in-ICU and hospital, after-hours discharge from ICU and readmission to ICU.

Results

In total, 6563 (39.5%) patients were cared for in ICUs with >75% CCRN, 7695 (46.3%) in ICUs with 50-75% CCRN, and 2360 (14.2%) in ICUs with <50% CCRN. In-hospital mortality was 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%) respectively. After adjusting for confounders, patients cared for in ICUs with 50-75% CCRN (adjusted OR 1.21 [95% CI 1.02-1.45]) were more likely to die compared to patients in ICUs with >75% CCRN. A similar but non-significant trend was seen in ICUs with <50% CCRN (adjusted OR 1.21 [95% CI 0.94-1.55]), when compared to patients in ICUs with >75% CCRN. In-ICU mortality, delirium, pressure injuries, after-hours discharge and ICU length of stay were lower in ICUs with CCRN>75%.

Conclusion

The nursing skill-mix in ICU impacts outcomes and should be routinely monitored. Health system regulators, hospital administrators and ICU leaders should ensure nursing workforce planning and education align with these findings to maximise patient outcomes.

Florence Nightingale: Legacy, present and perspectives in COVID-19 pandemic times

OBJECTIVE

Reflect on the influence of Florence Nightingale's teachings to face the COVID-19 pandemic and its repercussions for the future of the profession.

METHODS

Descriptive reflective study, carried out between May and July 2020, through narrative review on the theme and debates between the authors.

RESULTS

The findings are divided into two chapters, namely: Environmental Theory and the teachings of Florence Nightingale in the face of the COVID-19 pandemic; and Florence Nightingale: legacy, present and perspectives.

FINAL CONSIDERATIONS

Florence Nightingale's studies with the Environmentalist Theory and her teachings as a nurse are still valid, even after almost two centuries since her prelude, and should continue to serve as a foundation for the consolidation of the nursing profession.

'It was difficult, but our struggle to touch lives gave us strength': The experience of nurses working on COVID-19 wards

BACKGROUND

Nurses are considered important healthcare professionals during the management of the pandemic process due to the considerable amount of time they spend in the face-to-face nursing of infected patients. To optimise the service of healthcare workers, it is recommended that the mental health needs of the health workforce are addressed.

AIMS AND OBJECTIVES

This study aimed to explore the experiences and coping strategies of Turkish nurses working in pandemic units.

METHODS

A grounded theory design was applied. In-depth interviews were conducted with 15 nurses. The data were analysed according to the constant comparative method.

RESULTS

The study generated a core category ('It was difficult working in the unknown, but our struggle to touch lives gave us strength'), showing that all nurses felt heroic via the satisfaction of touching patients' lives and uncertain. Four main categories emerged: being caught in the pandemic, empowerment for coping with the struggle, challenges during the coping process and effects of the pandemic on life.

CONCLUSIONS

Nurses felt that their profession was sacred and valued by society, and comprehensive support had facilitated the process. Nurses had difficulty in managing their fear of infecting others and adapting to many new elements, the learning process and a lack of understanding of their role as team members. The nurses attending to the pandemic have experienced the effects of COVID-19 on their lives, such as psychological growth, psychological symptoms and being labelled as high risk.

RELEVANCE TO CLINICAL PRACTICE

Nurses would be further empowered by government and society's support and acceptance of professionalism in nursing. The findings suggest that the resources for the psychological support of nurses in the pandemic should be increased. Regular and intensive training for nursing is necessary to promote adaptation and efficacy in crisis management.