Nursing in the U.S.A

The Judgment of Senior Critical Care Nurses is Vital

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Modernizing the approach to critical care and improving the provision of nursing care for critically ill patients are key health care challenges, according to the Royal College of Nursing (RCN). A new publication, entitled Guidance for Nurse Staffing Critical Care was launched by RCN general secretary Beverly Malone, M.D. on Feb. 10. The guide looks at the role, responsibility and contribution of a critical care nurse to the critically ill patient and family and identifies principles and considerations for nurses to aid the decision making process, ensuring better patient centered care.

It is crucial that critical care nurses have the right skills, knowledge and competencies to meet the needs of critically ill patients. An important role of a critical care nurse is the continuous observation of critically ill patients. Observation involves assimilation, interpretation and evaluation of information. The RCN believe only appropriately trained and experienced nursing staff can provide this comprehensive level of observation. However, critical care nurses' skill level is dependent upon their knowledge, experience with, and exposure to, critically ill patients.

Every patient, nurse and care facility is different. Critically ill patients have a wide range of diagnoses and are cared for in a range of different settings, therefore it is not possible to determine the number of nurses needed by simplistic formulae.

The availability, experience and input of the multi-professional team will also influence nurse staffing levels. Judgments about the numbers of nurses and the skill level required are complex. However, the RCN believes that putting the power in the hands of senior critical care nurses to make these decisions is essential in ensuring appropriate patient care.

Close monitoring and observations can reduce a patient's risk of deterioration and additional complications. The RCN supports the work of critical care outreach teams in improving patient outcomes and preventing possible admissions to critical care areas.

The guidance for nurse staffing in critical care calls for the educational and evidence based recommendations to be recognized in the provision of critical care. These recommendations are:
  • A network-wide induction packages that incorporate core critical care competencies
  • A range of initiatives to meet the education and training needs, including leadership and managerial skills
  • Further research to determine the contribution that skilled nurses make to positive patient outcomes
  • A more sophisticated and realistic approach must be adopted when determining staffing levels, if patient care is not to be compromised.

Source: The Royal College of Nursing (RCN)