Critical care is recognised as a speciality in healthcare that is resource and workforce heavy, and that staffing and working conditions have been key nursing organisation challenges across the world (Williams, Schmollgruber & Alberto, 2006). The dynamic challenges that critical care is facing due to COVID-19 will place greater strain on nursing resources and may challenge volume based ratios, such as patient-nurse ratio of 1:1 or 1:2 models. Dynamic and prototype models of nursing models of care may need to be considered to meet the enormous burden of COVID-19 on critical care services.
Critical care nursing responsibilities of patient assessment, observation, care and supervision are complex when balancing the patients changing conditions, monitoring and technological interventions. The complexity of critical care nursing is a major factor in underestimating nursing workload, that workload tools such as Nurse Activities Score (NAS) just don’t factor in (Griffiths & Safer Nursing Care Study Group, 2020). Factors such as decision making is impacted by the patient situation, resource availability and interpersonal relationships (Bucknall, 2003).
Take a look at education standards and expectations for your countries critical care registered nursing (CCRN) qualification and ask yourself how can this be learned in a shorter space of time? Is it possible, is it reasonable, is it achievable to create a ‘nursing101’ education for general registered nurses or is it better to focus on changing the model of care? Many questions, but the 1:1 or 1:2 ratio model may not be achievable so here is a model based around a ‘team of teams’ approach that we would love comments on. Please feel to be as robust in the discussion as you feel necessary to our idea, but respectful to audience comments.
Team of Teams New Model of Critical Care Nursing Structure
As the demand on nursing team increases then it may be required to use the CRRN coordinating a team of general registered nurses. Essential skills will be communication, feedback and education to deliver this model of care.
Bucknall, T. (2003). The clinical landscape of critical care: nurses’ decision‐making. Journal of Advanced Nursing, 43(3), 310-319.
Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., Monks, T., & Safer Nursing Care Study Group. (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies, 103, 103487.
Miranda, D. R., Nap, R., de Rijk, A., Schaufeli, W., & Iapichino, G. (2003). Nursing activities score. Critical Care Medicine, 31(2), 374-382.
Nursing Education Network. (2020). Team of Teams.
Williams, G., Schmollgruber, S., & Alberto, L. (2006). Consensus Forum: worldwide guidelines on the critical care nursing workforce and education standards. Critical Care Clinics, 22(3), 393-406.