Page 50 - ACCCN's Critical Care Nursing

Resourcing Critical Care 27

The following example is for a six-bed intensive care unit. A roster has been determined to employ six
nurses using a three-shift/day approach (morning, evening, night [10 h]). A 2-hour morning (a.m.) to
afternoon (p.m.) shift handover period, and a 30-minute afternoon to night (ND) shift handover period, is
included. Local shift times and practices can be substituted.
Step 1 Calculate the number of working hours needed:

a.m. shift 0700 to 1530 = 7.6 h × 6 nurses × 7 days 319.2 h
p.m. shift 1330 to 2200 = 7.6 h × 6 nurses × 7 days 319.2 h
Night shift 2130 to 0730 = 10 h × 6 nurses × 7 days 420 h
Total 1058.4 h

These initial figures do not include sick leave or annual leave. An additional adjustment is therefore required
to factor in paid, unpaid, sick and study leave. A 22% ‘leave allowance’ is included to accommodate these
aspects. A locally derived figure may be substituted here, usually available from the finance or personnel
department.
Step 2 Adding the leave allowance:
1058.4 h × 1.22 (leave allowance) = 1291.2 h/38 h (1 FTE) = 33.9 FTEs
With a staffing pattern of six staff per shift, this unit requires an establishment of 33.9 full-time equivalents
(FTEs) to meet the needs of this roster. This figure does not include positions such as the nurse unit
manager, team leader/shift coordinator and clinical nurse educator, as outlined in the ACCCN guidelines 30
and Table 2.5.

FIGURE 2.1 Calculating staff requirements.

care settings at the time of the most recent annual review morning and evening shifts, with the option of a 10-hour
of intensive care resources in New Zealand. 34 night shift (Figure 2.1). With the increased demand for
flexible rosters has come the introduction of additional
Other professional organisations have also developed shift lengths, most notably the 12-hour shift. The imple-
position statements on the use of staff other than regis- mentation of a 12-hour roster requires careful consider-
tered nurses in the critical care environment. 54,55 The ation of its risks and benefits, with full consultation of all
Canadian Association of Critical Care Nurses (CACCN) parties, unit staff, hospital management and the relevant
states that non-regulated personnel may provide non- nurses’ union. Perceived benefits of working a 12-hour
direct and direct patient care only under the supervision roster include improvement in personal/social life,
54
of registered nurses. The British Association of Critical enhanced work satisfaction and improved patient care
Care Nurses (BACCN) similarly determines that health- continuity. Perceived risks, such as an alteration in the
care assistants employed in a critical care setting must level of sick-leave hours, decreased reaction times and
undertake only direct patient care activities for which reduced alertness during the longer shift, have not been
they have received training and for which they have been found to be significant. A reported disadvantage of
56
assessed competent under the supervision of a registered 12-hour shifts is the loss of the shift overlap time, which
nurse. 55
has traditionally been used for providing in-unit educa-
Staffing levels and skill mix within Australian and New tional sessions. A consideration, therefore, for units
Zealand units should therefore be based on individual proposing the implementation of a 12-hour shift pattern
unit needs (e.g. unit size and location) and patient clini- is to build formal staff education sessions into the
cal presentations/acuity, and be guided by the best avail- proposal.
able evidence to ensure safe, quality care for their
patients. EDUCATION AND TRAINING
In the mid-1990s, specialist critical care nursing qualifica-
ROSTERING tions made the transition from hospital-based courses to
Once the nursing establishment for a unit is determined the tertiary education sector. While some hospitals main-
and skill mix considered, the rostering format is decided. tain in-house critical care courses, these are generally
In this time of nursing shortages, one of the factors identi- designed to meet the tertiary requirements of postgradu-
fied as affecting the retention of staff is the ability to ate education and to articulate with higher-level univer-
provide flexibility in rostering practices. To some extent, sity programs.
rostering practices are governed by individual state
nursing awards, and these should be considered when Some organisations, both private and public, continue to
deciding the roster format for individual units. offer a variety of short continuing education courses as
well, generally at a fairly basic level of knowledge and
The traditional shift pattern is contingent on a 38-hour skills, but which play a role in providing an introduction
31
per week roster for full-time staff and is based on 8-hour for a novice practitioner. Position statements on the