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      Workforce management and patient outcomes in the intensive care unit during the COVID‐19 pandemic and beyond: a discursive paper

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          Abstract

          Aims

          To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.

          Background

          In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.

          Design

          Discursive paper.

          Findings

          Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.

          Conclusion

          COVID‐19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under‐resourced changes to workload, and this has been brought into stark visibility with the current COVID‐19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.

          Relevance to clinical practice

          Objective measures commonly fail to capture the complexity of the critical care nurses’ role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.

          Related collections

          Most cited references82

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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            The job demands-resources model of burnout.

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              Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations

              Summary As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.
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                Author and article information

                Contributors
                Role: DirectorR.Wynne@westernsydney.edu.au
                Role: Vice‐Chancellor ad Principal
                Role: Professor
                Role: Research Academic Director
                Role: Senior Research Fellow
                Journal
                J Clin Nurs
                J Clin Nurs
                10.1111/(ISSN)1365-2702
                JOCN
                Journal of Clinical Nursing
                John Wiley and Sons Inc. (Hoboken )
                0962-1067
                1365-2702
                28 June 2021
                28 June 2021
                : 10.1111/jocn.15916
                Affiliations
                [ 1 ] Western Sydney Nursing & Midwifery Research Centre Blacktown Clinical & Research School Western Sydney University & Western Sydney Local Health District Blacktown Hospital New South Wales Australia
                [ 2 ] School of Nursing & Midwifery Deakin University Geelong Victoria Australia
                [ 3 ] Johns Hopkins University School of Nursing Baltimore Maryland USA
                [ 4 ] Faculty of Health University of Technology (UTS Sydney New South Wales Australia
                [ 5 ] School of Nursing & Midwifery Edith Cowan University Perth Western Australia Australia
                [ 6 ] Susan Wakil School of Nursing The University of Sydney Sydney New South Wales Australia
                Author notes
                [*] [* ] Correspondence

                Professor Rochelle Wynne, Director & Professor of Nursing, Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District.

                Email: R.Wynne@ 123456westernsydney.edu.au

                Author information
                https://orcid.org/0000-0003-1814-3416
                https://orcid.org/0000-0003-0299-6289
                https://orcid.org/0000-0001-5252-5325
                https://orcid.org/0000-0002-2417-2216
                Article
                JOCN15916
                10.1111/jocn.15916
                8447459
                34184349
                6afe7501-a523-4c72-afd2-fa1f8862b03f
                © 2021 John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 12 April 2021
                : 05 January 2021
                : 20 May 2021
                Page count
                Figures: 0, Tables: 0, Pages: 10, Words: 24850
                Categories
                Special Issue Discursive Paper
                Special Issue Discursive Papers
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.7 mode:remove_FC converted:17.09.2021

                Nursing
                covid‐19,critical care,intensive care unit,mortality,nurse staffing,workforce
                Nursing
                covid‐19, critical care, intensive care unit, mortality, nurse staffing, workforce

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