Workforce Standards for Intensive Care Nursing (ACCCN)
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WORKFORCE STANDARDS FOR INTENSIVE CARE 2016 NURSING Suggested Citation Australian College of Critical Care Nurses (2016). Workforce Standards for Intensive Care Nursing. Melbourne, ACCCN Ltd ISBN 9 780646 960739 Available at: www.acccn.com.au/aboutus/position-statements-standards ACKNOWLEDGEMENTS Standards Development Group Standards Document Reviewers Dianne Callahana RN,MN ACCCN Paediatric Advisory Panel Diane Chamberlaina RN, PhD ACCCN Quality Advisory Panel Naomi Fayers RN, MN ACCCN Workforce Advisory Panel Bernadette Grealy RN,MN Key stakeholders Lyn Hopper RN, BSc (ICU Cert) Geraldine Kucharski RN, BN Standards Appraisal Claudia Matthews RN, MN Intensive Care Services Network, Agency for Clinical Innovation, Veronica McCartan RN, M lnt Care Nurs New South Wales Wendy Pollocka RN, PhD (Chair) Jackie Roberts-Thompsona RN, MN Systematic Review Librarian Tracey Swiney RN, MLN Raechel Damarell BA, Grad Dip lnfo Stud Standards Evidence Reviewers Research Assistant Diane Chamberlaina RN, PhD Naomi Knoblach BSc (Hons) Raechel Damarell BA, GDinfoStud Naomi Knoblach RN, BSci Wendy Pollocka RN, PhD Standards Writing Group Diane Chamberlaina RN, PhD Paul Fulbrooka RN, PhD Wendy Pollocka RN, PhD a Director, ACCCN Board 1 CONTENTS Foreword...................................................................3 Executive Summary..........................................................4 Standards in Summary............................................................5 ACCCN Workforce Standards for Intensive Care Nursing.......................6 Context....................................................................6 Patient Experience...............................................................6 Background.................................................................7 Funding....................................................................7 Conflicts of interest...............................................................7 Purpose....................................................................7 Scope....................................................................7 Target users..................................................................7 Methods..................................................................7 Results...................................................................8 Pragmatic Issues of evidence.........................................................8 Body of evidence................................................................8 Derivation of the Standards..........................................................8 Review and minor revision of the Standards................................................8 Appraisal...................................................................9 Ratification..................................................................9 Dissemination................................................................9 Implementation of the Standards.......................................................9 Review...................................................................10 Audit.....................................................................10 Standard One..............................................................11 Standard Two..............................................................12 Standard Three............................................................13 Standard Four.............................................................14 Standard Five.............................................................15 Standard Six..............................................................16 Standard Seven............................................................17 Standard Eight............................................................18 Standard Nine.............................................................19 Standard Ten..............................................................20 References................................................................21 Appendix A: Definitions...........................................................30 Appendix B: Evidence Tables.......................................................32 Appendix C. Body of Evidence......................................................34 2 FOREWARD On behalf of the Australian College of Critical Care Nurses is imperative to ensure patient safety, enhance staff recruitment (ACCCN) Board of Directors, it is my pleasure to present the and retention, and maintain an organisation's financial viability. ACCCN Workforce Standards for Intensive Care Nursing. The goal of the Standards is to ensure that quality care is The intensive and critical care nursing workforce plays an provided in an environment that is safe and has a positive impact essential role in the achievement of healthcare outcomes. A on patient and nursing outcomes. This document puts forth 10 growing body of evidence clearly demonstrates that inadequate essential standards for establishing and sustaining an intensive nurse staffing leads to an increase in negative outcomes care nursing workforce as part of a healthy work environment for patients, and ultimately a greater burden of cost to both that supports and fosters excellence in patient-centred care. the healthcare budget and society. Insufficient staffing and These landmark standards represent an important step in fulfilling inadequate skill mix are potentially compromising nurses' ability to ACCCN's commitment to its mission - to lead, represent, develop maintain the safety of those in their care, and to provide a level of and support critical care nurses in Australia. care that is likely to satisfy the nurses who provide the care and the patients who are the recipients of the care. Unhealthy work environments contribute to medical errors, Diane Chamberlain RN, PhD ineffective delivery of care, and conflict and stress amongst President, ACCCN health professionals. The creation of healthy work environments October 2016 3 EXECUTIVE SUMMARY The Australian College of Critical Care Nurses (ACCCN) is the improve patient outcomes.1-5 Specifically, higher ratios of RNs peak professional nursing body representing critical care nurses providing direct patient care are associated with reduced length in Australia. of stay in ICUs, reduced incidence of nosocomial infection, fewer The ACCCN Workforce Standards for Intensive Care Nursing adverse events and lower ICU mortality. has been developed to safeguard the provision of an appropriate Although there are many factors that influence the safety and intensive and critical care nursing workforce, with the aim to outcomes of critically ill patients, it is indisputable that patient- ensure a safe and sustainable workforce that achieves the best centred care provided by an appropriately qualified nursing outcomes for critically ill patients. workforce makes a significant difference. Since the publication of the Institute of Medicine's report To Err Is In 2012, the Department of Health and Ageing commissioned a Human1, the relationship between hospital characteristics such review of Australian government health workforce programs, with as intensive and critical care nurse staffing and the quality of care a focus on how to support the delivery of a high-quality, well- has become central to issues of healthcare delivery, research distributed, optimally utilised and responsive health workforce and policy. In the acute hospital setting, there is a long-standing, for Australia.6 The chair of the review stated, 'it is critical that consistent and robust evidence base that demonstrates the workforce innovation results in not only improved productivity, positive associations between the number of registered nurses improved retention and job satisfaction but also that the safety (RNs) employed to care for patients, the quality of their education, and quality of care is not affected ' (p. 72). These concepts sit at and improved patient outcomes. Furthermore, in intensive care the heart of the 2016 ACCCN Workforce Standards for Intensive units (ICUs), there is evidence that higher ratios of RN staff to Care Nursing. patients (specifically, 1:1 or 1:2) increase patient safety and 4 STANDARDS IN SUMMARY Standard One Standard Seven Life support equipment for specialised diagnostic or therapeutic The ICU patient case mix and unit design must determine the procedures must be managed by a suitably skilled and qualified appropriate nursing service, knowledge and skills required for the RN. nursing workforce and support staffing of each unit. In addition to the minimum levels of staffing identified in Standards 2-10, each ICU must be evaluated objectively in Standard Eight terms of its unique patient case mix, design and environment to A liaison nurse service must be provided to optimise the use of determine whether additional staffing is required to safely meet the ICU within the hospital. the needs of its patients. Standard Nine Standard Two Intensive care nursing practice must be supported by a suitably A specified (formula/ratio based) number of nursing staff, with skilled and qualified RN researcher. suitable knowledge and skills, must be employed to provide direct patient- and family-centred care to critically ill patients. Standard Ten Standard Three Non-nursing staff, such as administrative, clerical, cleaning and equipment support staff that are based in the ICU, must be A specified (formula/ratio based) proportion of the nursing staff in provided to support service delivery and ensure that the nursing an ICU must hold a specialist