Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID‐19 pandemic and potential solutions

Abstract

Aims and ObjectivesThe critical care nursing workforce is in crisis, with one‐third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.DesignDiscursive/Position paper.MethodThe discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer‐reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.ResultsCritical care nurses have been disproportionately affected by the COVID‐19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post‐traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence‐based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.ConclusionsWe conclude that critical care nurses are in urgent need of preventative, evidence‐based wellbeing interventions, and make suggestions for research and practice.

Promoting Well-being: A Scoping Review of Strategies Implemented During the COVID-19 Pandemic to Enhance the Well-being of the Nursing Workforce

“…The factors outlined in these themes is consistent with the broader literature on promoting and supporting well-being amongst nurses and other healthcare professionals, and the growing body of evidence surrounding the impact the COVID-19 pandemic had on the wellbeing of the nursing workforce ( Ball et al., 2023 , Cornish et al., 2021 , Doleman et al., 2023 , Holton et al., 2021 , Nantsupawat et al., 2023 , Vogt et al., 2023 )) . The themes provide insight into developing well-being interventions that are effective and adaptable for any future crisis that requires rapid action by nursing leaders and managers.…”

“…The barriers identified to accessing well-being interventions highlight that the introduction of wellness interventions in isolation will not reduce nurse burnout or turnover but must be accompanied by organizational interventions to address staffing levels, patient acuity, and lack of resources. Well-being initiatives that enhance resilience and psychological safety are an important step in healthcare settings recognizing the importance of supporting the mental health of their staff, but leaders and managers must also ensure a safe working environment through adequate staffing and resources, flexible scheduling, and access to mentoring and clinical supervision to maintain a culture of safety ( ( Doleman et al., 2023 ); Haughland et al., 2023; ( Vogt et al., 2023 ).…”

“…Evaluations of strategies designed to improve resilience and well-being were often given a lower priority to operational needs, clinical concerns, or the well-being of other staff, or that whilst staff were aware of the initiatives, they did not access them (Holten et al, 2022). Therefore, wellbeing interventions introduced by healthcare organizations should be well targeted, but also regularly evaluated to ensure they are effectively supporting their workforce ( Vogt et al., 2023 ).…”

Person-Centred Critical Care: Lessons from a Service Evaluation

“…Staff also suffered, through moral injury and burnout due to the daily scale of distress witnessed and the inability to provide person-centred care due to workload pressures (Calkins et al 2023). Many critical care staff have left the profession, replaced by younger and less experienced staff, some of whom only know nursing in the context of the pandemic (Vogt et al, 2023).…”

Nurses' job burnout after the first peak of COVID-19 in Northeast China: a descriptive study

“…It is re ected in core characteristics such as emotional exhaustion, personality disintegration, and lack of personal achievement [4]. The increase in patients can also lead to an increase in speci c factors of job burnout, including increased workload, faster work rhythm, increased rescue probability, increased risk of medication errors, and di cult ethical dilemmas to face [5,6]. Job burnout among nurses can have multiple hazards for patients, medical institutions, and nurses themselves.…”