DOI QR코드

DOI QR Code

The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study

중환자 간호요구도에 근거한 중환자실 간호사 배치수준 산정 : 다기관 연구

  • Received : 2020.12.01
  • Accepted : 2021.06.10
  • Published : 2021.06.30

Abstract

Purpose : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients' nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods : In a cross-sectional survey conducted in September 2017, 1,786 patients' WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients' nursing care needs were calculated. Results : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients' nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Keywords

Acknowledgement

본 연구는 2017년 병원중환자간호사회에서 연구비를 지원받아 진행한 연구임

References

  1. Elliott D, Aitken L, Chaboyer W, Marshall A. ACCCN's critical care nursing. 2nd ed. Chatswood, NSW: Elsevier Australia; 2011. p. 3-16.
  2. Penoyer DA. Nurse staffing and patient outcomes in critical care: a concise review. Critical Care Medicine. 2010;38(7):1521-8. https://doi.org/10.1097/CCM.0b013e3181e47888
  3. Griffiths P, Maruotti A, Saucedo AR, Redfern OC, Ball JE, Briggs J, et al. Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Quality & Safety. 2019; 28(8):609-17. http://dx.doi.org/10.1136/bmjqs2018-008043
  4. Needleman J, Liu J, Shang J, Larson EL, Stone PW. Association of registered nurse and nursing support staffing with inpatient hospital mortality. BMJ Quality & Safety. 2020;29(1):10-8. http://dx.doi.org/10.1136/bmjqs-2018-009219
  5. Lankshear AJ, Sheldon TA, Maynard A. Nurse staffing and healthcare outcomes: a systematic review of the international research evidence. Advances in Nursing Science. 2005;28(2):163-74. https://doi.org/10.1097/00012272-200504000-00008
  6. Kim Y, Cho S-H, June KJ, Shin SA, Kim J. Effects of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients. Journal of Korean Academy of Nursing. 2012;42(5):719-29. http://doi.org/10.4040/jkan.2012.42.5.719
  7. Shang J, Needleman J, Liu J, Larson E, Stone PW. Nurse staffing and healthcare-associated infection, unit-level analysis. The Journal of Nursing Administration. 2019;49(5):260-5. https://doi.org/10.1097/NNA.0000000000000748
  8. Moisoglou I, Galanis P, Meimeti E, Dreliozi A, Kolovos P, Prezerakos P. Nursing staff and patients' length of stay. International Journal of Health Care Quality Assurance. 2019;32(6):1004-12. https://doi.org/10.1108/IJHCQA-09-2018-0215
  9. Cho S-H, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. International Nursing Review. 2015;62(2):267-74. https://doi.org/10.1111/inr.12173
  10. Tubbs-Cooley HL, Mara CA, Carle AC, Mark BA, Pickler RH. Association of nurse workload with missed nursing care in the neonatal intensive care unit. JAMA Pediatrics. 2019;173(1):44-51. https://doi.org/10.1001/jamapediatrics.2018.3619
  11. Bray K, Wren I, Baldwin A, St Ledger U, Gibson V, Goodman S, et al. Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum. Nursing in Critical Care. 2010;15(3):109-11. https://doi.org/10.1111/j.1478-5153.2010.00392.x
  12. Chamberlain D, Pollock W, Fulbrook P. ACCCN workforce standards for intensive care nursing: systematic and evidence review, development, and appraisal. Australian Critical Care. 2018;31(5):292-302. https://doi.org/10.1016/j.aucc.2017.08.007
  13. Lee H, Bae H. The association of nurse staffing levels and patient outcome in intensive care units. Korean Journal of Critical Care Medicine. 2013;28(2):75-9. https://doi.org/10.4266/kjccm.2013.28.2.75
  14. Health Insurance Review & Assessment Service (HIRA). 2017 Evaluation report of intensive care unit appropriateness [Internet]. Wonju: HIRA; 2018 [cited 2021 June 14]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2018_13.pdf
  15. Cho S-H, Lee J-Y, Hong KJ, Yoon H-J, Shim W-H, Kim M-S, et al. Determining nurse staffing by classifying patients based on their nursing care needs. Journal of Korean Academy of Nursing Administration. 2020;26(1):42-54. https://doi.org/10.11111/jkana.2020.26.1.42
  16. American Nurses Association. Principles for nurse staffing. 2nd ed. Silver Spring Maryland: American Nurses Association; 2012.
  17. Cho YA, Shin HJ, Cho J-K, Chung MK, Lee BN, Song KJ. Development and application of the Workload Management System for Critical care Nurses (WMSCN) using WMSN. Journal of Korean Clinical Nursing Research. 2005;11(1):71-84.
  18. Yoo CS, Sim MY, Choi EH. Development of Korean Patient Classification System for Critical Care Nurses. Journal of Korean Clinical Nursing Research. 2015; 21(3):401-11. https://doi.org/10.22650/JKCNR.2015.21.3.401
  19. Park YS, Song R. Estimation of nurse staffing based on nursing workload with reference to a patient classification system for a intensive care unit. Journal of Korean Critical Care Nursing. 2017;10(1):1-12.
  20. Youn SH, Son H-S, Kim J, Jung K, Moon J, Huh Y, et al. Trauma versus nontrauma intensive care unit nursing: a workload comparison. Journal of Trauma Nursing. 2020;27(6):346-50. https://doi.org/10.1097/JTN.0000000000000541
  21. Cho S-H, Song KJ, Park IS, Kim YH, Kim MS, Gong DH, et al. Development of staffing levels for nursing personnel to provide inpatients with integrated nursing care. Journal of Korean Academy of Nursing Administration. 2017;23(2):211-22. https: //doi.org/10.11111/jkana.2017.23.2.211
  22. Cho S-H, Lee J-Y, June K-J, Hong KJ, Kim Y. Nurse staffing levels and proportion of hospitals and clinics meeting the legal standard for nurse staffing for 1996~2013. Journal of Korean Academy of Nursing Administration. 2016;22(3):209-19. https://doi.org/10.11111/jkana.2016.22.3.209
  23. Kang H-J. Policy direction for decreasing the concentration of patients to extra-large hospitals. Health and Welfare Policy Forum. 2014;210(0):65-76.
  24. Ministry of Health and Welfare. Medical service act [Internet]. Sejong: Ministry of Health and Welfare; 2021 [cited 2021 May 20]. Available from: http://www.mohw.go.kr/upload/viewer/skin/doc.html?fn=1439872497458_20150818133457.hwp&rs=/upload/viewer/result/202105/
  25. Ministry of Health and Welfare. Press release: the burden of admission charge will be reduced to half for a double room and a triple room at tertiary and general hospitals from July 1st [Internet]. Sejong: Ministry of Health and Welfare; 2018 [cited 2021 May 19]. Available from: https://bit.ly/3eLBexQ

Cited by

  1. Factors influencing intention to intervene in elder abuse among nursing students vol.9, 2021, https://doi.org/10.7717/peerj.12079