icu

The ICU From the Nursing Perspective

　　Connie Jastremski, RN,[17] of Rome Memorial Hospital, Rome, New York, provided the nursing perspective to this discussion. She focused on the impact of nurse staffing on outcome. There is a growing nursing shortage today. The reasons for the shortage include the low enrollments in nursing schools and the increasing numbers of chronically ill patients. This shortage poses a major risk for patient safety. As a result of work overload, nursing staff may provide suboptimal patient care. Simple measures like hand washing may be omitted, with the result being a subsequent increase in nosocomial infections.
　　The effect the nursing shortage may have on patient care was examined in a recent study by Aiken and associates.[10] A total of 10,184 staff nurses were surveyed, and 232,342 general, orthopedic, and vascular surgery patients, discharged from the hospital between April 1, 1998, and November 30, 1999, were studied. After adjusting for patient and hospital characteristics, it was shown that each additional patient per nurse incurred a 7% (OR, 1.07; 95% CI, 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue (defined as deaths following complications). Additionally, each extra patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction. These results have a significant impact as California passed legislation mandating patient-to-nurse ratios for its hospitals, which goes into effect in July 2003 (ICU nurse-to-patient ratio 1:2). Other states are following. Ms. Jastremski concluded that it is hoped that mandatory nursing staffing ratios will decrease the existing work load, help attract young people into the profession, and eventually help decrease patient morbidity and mortality.