Sustainable, safe ICU staffing: an interview study with ICU Nurse Unit Managers.

Abstract

Introduction: Adequate Intensive Care Unit (ICU) staffing is an ongoing concern for hospitals, amplified by the COVID-19 pandemic, as staffing is related to patient outcomes. ICU Nurse Unit Managers (NUMs) are at the forefront of this challenge, responsible for both recruitment of ICU staff and adverse event management. Objective: To explore the views of ICU NUMs on what constitutes sustainable, safe ICU staffing. Method: All 47 Victorian ICU NUMs were grouped based on characteristics of their experience e.g. location (metro/regional); level of service; public/private etc. Following ethics approval, we sent an email invitation to randomly selected ICU NUMs using maximum variation sampling. Following consent, individual interviews took place on Zoom (auto-transcribed). The interview themes inquired about sustainable staffing, safe staffing, challenges in recruiting and maintaining skilled staff, support for novices, and the impacts of COVID-19. After transcripts were cleaned, Ritchie and Spencer’s Framework Analysis was used with each transcript coded by two researchers, followed by an analysis workshop involving the research team. Results: Twelve ICU NUMs with a variety of experiences participated in interviews lasting approximately one hour. Safe staffing was viewed as having multiple elements including the patient’s sense of feeling safe, absence of harm to the patient, absence of physical harm to the nurse and the individual staff member feeling safe in the team culture. Sustainable staffing included individual (flexible rostering, support and development opportunities) and unit (‘grow your own’, adequate support for novices) elements, with redeployment out of ICU a consistent major negative. Conclusion: Whilst ‘grow your own’ is a strategy to build an ICU workforce, tactics to retain experienced ICU staff should have a stronger focus if a sustainable, safe ICU workforce is to be achieved.