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ICU nurses are working harder than ever and facing increased challenges in patient care — not only in their traditional clinical roles, but in ethical and legal arenas, as well.
A greater emphasis on complex technology, managed care, and increasing populations of sicker patients are all challenging conventional ICU nursing skills and forcing changes in professional standards that have traditionally defined the ICU nurse.
Those factors run throughout critical care and are affecting nurses in all specialties, including adult, pediatric, and neonatal care.
Those are the findings of the latest nursing role delineation study conducted annually by the American Association of Critical Care Nurses (AACN) Certification Corp. in Aliso Viejo, CA.1
Those issues have come to the forefront in our profession in recent years, and the latest delineation study now bares this out, says Melissa Biel, RN, MSN, executive director of the AACN Certification Corp., which sponsors the critical care registered nurse (CCRN) certification exam.
The study revealed several common themes among all patient age groups, including:
• an increase in psychosocial issues in relation to patient care not only with patients but also with patients’ families;
• growing awareness by nurses of ethical and legal dilemmas in ICU patient care;
• increased use of technology and new clinical procedures;
• new leadership opportunities for nurses in working with multidisciplinary teams and unlicensed personnel;
• changing patient demographics;
• shorter lengths of stay, increase in patient-to-nurse staffing ratios, and sicker patients as a function of managed care payment policies.
As for psychosocial issues, according to the study, nurses are finding themselves working with families who have a history of poverty and homelessness.
Mental illness, drug abuse, and domestic abuse are now common for patients and patients’ families, particularly in neonatal ICUs, the report stated.
These conditions have increased the number of cases of shaken baby syndrome, iatrogenic withdrawal, and other abuses.
Study respondents indicated that ICUs are seeing older and sicker patients who are more acutely or critically ill and suffering from comorbidities.
Patients also are taking more medication than in the past and using more technology. Nurses are also seeing a greater role played by insurance in determining when patients decide to seek medical care.
According to Biel, the findings of the latest study will be incorporated into the blueprint used by AACN in its CCRN certification exam.
1. Biel M, Eastwood J, Muenzen P, et al. Evolving trends in critical care nursing practice: Results of a certification role delineation study. Am J Crit Care 1999; 8:285-290.