Nursing Workforce Characteristics and Their Impact on Intensive Care Unit Interprofessional Team Collaboration

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INTRODUCTION: Nursing workforce characteristics, such as staffing and specialized training, are integral to the delivery of high-quality patient care in the intensive care unit (ICU). Nurse staffing is defined as the number of nurses per patient but also skill-mix (combination of registered nurses and other nursing support staff) and expertise of available nurses for the specific patient population each shift. When nurse staffing is suboptimal the risk of adverse patient outcomes and patient mortality increases. In addition, existing research has established the importance of staffing ICUs with interprofessional teams-registered nurses (RNs), physicians, and respiratory therapists (RTs). Yet, shifting characteristics of the nursing workforce- such high turnover and a more novice workforce- are still under studied and may impact the interprofessional team and its ability to collaborate effectively. MATERIALS AND METHODS: This study is an analysis of previously collected qualitative data from 9 ICUs within a single academic medical system in the US. Participants (RNs, physicians, RTs, and other ICU providers) working in study ICUs across 4 hospitals were purposively sampled and interviewed individually. Thematic analysis was used to analyze interview transcripts; 2 researchers coded each transcript independently. Consensus on any coding disagreement was reached through discussions at research team meetings. Once all data was coded, the team iteratively reviewed the data and codes and generated themes that focused on the primary research question of this analysis: how nursing workforce characteristics influence the interprofessional team. RESULTS: Our final sample included RNs (n = 11), RTs (n = 4), physicians (n = 4), and a dietician (n = 1). Three interconnected themes were identified in the analysis: (1) The effects of a transition to a more novice nursing workforce in ICUs extends beyond nurse staffing to the interprofessional team and their ability to provide care; (2) Staffing decisions do not incorporate interprofessional team needs, leading to decreased collaboration and disruptions in patient care; and (3) Adequate nurse staffing and additional support can balance increased burden on the interprofessional team. These themes highlight how nurse workforce characteristics can influence the interprofessional team in adult ICUs in a post-COVID era. CONCLUSIONS: Characteristics of the nursing workforce, such as nurse experience and expertise, have downstream effects on interprofessional team members and their ability to deliver care in the ICU. A multi-pronged approach, which includes adequate support staff for nursing, increased retention of experienced ICU nurses, and improving communication across professions, is vital to improve interprofessional team collaboration and allow ICU teams to provide the best care possible to their patients.

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