The quality of Intensive Care nursing before, during, and after the introduction of nurses without ICU-training

The forecasted shortage of nurses specialized in intensive care seriously threatens the service level in the intensive care units (ICUs). This problem might partly be solved by introducing nurses without ICU experience who can provide basic nursing care to relieve the workload of the ICU nurses. This prospective controlled study was set up to determine whether such an introduction causes a significant shift in the quality of care.

A prospective observational study was conducted to measure possible changes in the quality of care by examining the number of predefined nursing errors per patient with an observational instrument, the Critical Nursing Situation Index (CNSI). The CNSI was randomly applied during a preassessment period, an intervention period, and a postassessment period. During the intervention period, 16 full time equivalent nurses were employed with the assignment to assist the ICU nurses with basic care activities for 6 months.

The study was conducted in a 30-bed ICU at the Academic Medical Center in Amsterdam.

The effect of the employment of nurses was expressed as the difference in the incidence of CNSI scores between the preassessment period and the intervention period on the basis of the relative risk ratios. The results of the comparison between the preassessment and the postassessment period were used to express the consistency of the measure.

The researchers completed 600 CNSI observations in 256 patients in 162 days. Overall incidence rates during the preassessment (13%; 1539/12 222) and postassessment (14%; 1554/11 327) period were comparable, whereas the intervention period showed a diminished overall incidence of 9% (1019/11 395). The overall relative risk (95% CL) was 0.70 (0.56/0.86), indicating a significant risk reduction during the intervention period.

The employment of nurses without ICU training improved the quality of care. This positive effect was primarily explained by the increase in available nursing time.