Abstract
Background
Critically ill patients in the intensive care environment require an appropriate nursing
workforce to improve quality of care and patient outcomes. However, limited information
exists as to the relationship between severity of illness and nursing skill mix in
the intensive care.
Objective
The aim of this study was to describe the variation in nursing skill mix across different
hospital types and to determine if this was associated with severity of illness of
critically ill patients admitted to adult intensive care units (ICUs) in Australia
and New Zealand.
Design & Setting
A retrospective cohort study using the Australia and New Zealand Intensive Care Society
Adult Patient Database (to provide information on patient demographics, severity of
illness, and outcome) and the Critical Care Resources Registry (to provide information
on annual nursing staffing levels and hospital type) from July 2014 to June 2020.
Four hospital types (metropolitan, private, rural/regional, and tertiary) and three
patient groups (elective surgical, emergency surgical, and medical) were examined.
Main outcome measure
The main outcome measure was the proportion of critical care specialist registered
nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total
RNs working within each ICU each year, as reported annually to the Critical Care Resources
Registry.
Results
Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study
period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand,
the median percentage of registered nursing FTE with a critical care qualification
for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9–71.6). The percentage
FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6–78.2)]
and tertiary ICUs [58.1% (IQR = 51.2–70.2)], followed by metropolitan ICUs [56.0%
(IQR = 44.5–68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9–70.0)].
In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher
severity of illness, most notably in tertiary and private ICUs. This relationship
was persistent across all hospital types when examining subgroups of emergency surgical
and medical patients and in multivariable analysis after adjusting for the type of
hospital and relative percentage of each diagnostic group.
Conclusions
In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing
teams with the highest percentage FTE of critical care specialist RNs. The Australian
and New Zealand healthcare system has a critical care nursing workforce which scales
to meet the acuity of ICU patients across Australia and New Zealand.
Keywords
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Article info
Publication history
Published online: January 31, 2023
Accepted:
November 23,
2022
Received in revised form:
November 22,
2022
Received:
March 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
