Critical Care Unit staffi ng (nursing)

Critically ill patients require close nursing supervision. Many will require high-intensity nursing throughout a 24h period while others are of a lower dependency and can share nurses. In addition to the bedside nurses, the department needs additional staff to manage the day-to-day running of the unit, to assist in lifting and handLing of patients, to relieve bedside nurses for rest periods, and to collect drugs and equipment. These additional nurses (or nurse assistants) can be termed the ‘fi xed nursing establishment’ and the nature of their duties is such that they will usually include the higher grade nurses. The bedside nurses are a ‘variable establishment’ and their numbers are dependent on activity such that more patients require higher numbers. Most departments fi x part of their variable establishment by assuming an average activity.

Fixed establishment

Providing one nurse per shift requires a rota of 5.5 nurses. In addition, staff handover, annual leave, study leave, and sickness are usually calculated at 22% such that one additional nurse is required. Thus, the provision of one nurse in charge of each shift and one nurse to support the bedside nurses requires 11 nurses in those two roles alone. In larger units, there may be a need for additional nurses supporting the nurse in charge.

Variable establishment

The same principles apply for the provision of bedside nurses. Thus, to provide 1:1 nursing for a bed requires 5.5 nurses and to provide 1:2 nursing requires 2.75 nurses. The total number required depends on the occupancy and the nurse-to-patient ratio for each occupied bed. One of the diffi culties in staffi ng a Critical Care Unit relates to the variable dependency and occupancy. An average dependency weighted occupancy (average occupancy x average nurse-to-patient ratio) should be used to set the establishment of bedside nurses with additional nurses being drafted in from a bank or agency to cover peak demands.

Skill mix

Nursing skill mix is the subject of much controversy as the need for economy is balanced against the need for quality. As stated above, the fixed nursing will usually be of higher grade since the role incorporates the administration of the unit and supervisory nursing. The bedside nurses will be made up of those who have received post-qualifi cation training in critical care and those who have not. The ratio of trained to untrained critical care nurses should be of the order of 3:1 to facilitate in-service teaching.