EVIDENCE BITS
This new series #NRSEvidenceBits by Nightingale Research Solutions aims to bridge the gap between research evidence and nursing practice. For our first topic, we will deal with Staffing during Epidemics. We'll have other important topics in the coming weeks too, so let us know if you have comments or practice questions that you want to be answered. Point your cursor to an image to view the summary.
In the twelve-hour shift model reported in literature on the Ebola epidemic, the number of duty hours was divided into shorter parts, of three to four hours each. This strategy considered experiences from hospital drills and staff feedback, such as comfort, tolerance, satisfaction with work conditions and personnel safety.
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A staffing model based on “buddy system” can be considered where two nurses are in the patient’s room at all times. One nurse can perform direct patient care while another can act as a monitor observing compliance to infection control procedures, obtaining supplies and assisting other staff members as needed. For units with critically ill patients requiring oxygen support, hourly monitoring and complex procedures, a nurse-to-patient ratio of 1-2:1 was required. For units with more stable patients, a nurse-patient ratio of 1:2 was recommended,
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Due to anticipated staff shortages in the critical care units in an epidemic, building and training an additional reserve staff is essential in ensuring that nursing staff are immediately available in the intensive care units, and that the reserve staff can be rapidly assimilated in the ICU team. To facilitate the prompt and seamless identification of reserve staff, it is also suggested that a register of staff with preceding ICU experience should be maintained with their consent.
Nurses perceive that there is a need to have improved communication in order to create a supportive and safe work environment towards better quality of care. In order to achieve this, specific recommendations have been made, such as: (1) a crisis communication plan should be developed, with the senior director or a deputy as the spokesperson, (2) channels of communication with hospital administration, hospital units, staff and relative should be delineated in the communication plan, and (3) daily briefing and debriefing sessions should be conducted to inform staff of the epidemic status and policy changes, and to facilitate feedback.
It is recommended that the staffing of containment care units or isolation units during epidemics, should be planned in advance; With careful consideration of the number of nurses and healthcare workers per shift. In determining the needs for a specialized area, attention should be given to patient acuity, the specialized skill set needed for that acuity, anticipated clinical interventions, and staff availability. The formulation of a successful staffing model is the result of the consideration of best available evidence by leadership, combined with staff input on the model that is best suited for the specific requirements of providing care to patients in an epidemic.
Limited training opportunities caused unnecessary anxiety for nurses. Training and education on evidence-based practices and protocols are crucial in ensuring the provision of appropriate, safe and quality nursing care during outbreaks, and can reduce fear, anxiety, and apprehension among nurses. Various education and training methods used include didactic lessons, slide presentation, video, return demonstration, knowledge assessment, poster, and simulation drills.
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Enacting a voluntary care model considers the ethical responsibility of nurses to provide care to all patients, while ensuring the fair allocation of responsibilities across the nursing workforce. Volunteers should be fully informed of the risks they are assuming, the effectiveness and availability of personal protective equipment, the additional compensation and benefits they will be receiving, and the availability of treatment for those who will be infected with the infectious disease.
It was recommended that staffing plans include contingencies in anticipation of staff illness and staff absence. An estimated 40 – 70% of staff may not be able to work during an influenza pandemic.
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Also included in contingency planning is the consideration of nursing staff belonging to vulnerable populations, and their area of deployment during an epidemic.
Due to the high volume of work and understaffing in their units, nurses experienced burnout over time and complained of getting off work later. During the SARS epidemic, a workload of more than two patients per healthcare worker is significantly associated with the occurrence of superspreading events in hospital wards (OR=2.76, 95% CI=1.16–6.57) . Meanwhile, a perceived increase in workload was also significantly associated with nurse’s consideration of leaving their job (aOR=3.73, 95% CI=1.82-8.24).
There are several determinants to skill mix such as in the event of staff or skill shortages, and situations that may require cost containment measures. This diversity in backgrounds and skill sets were deemed as beneficial not only for the patients, but also for the nurses as they are able to learn new skills from their colleagues during patient care. Essentially, staffing during epidemics should be planned in advance and should delineate the skill mix of the staff who will take charge of these units.
Nurses’ job descriptions and responsibilities were established by the nursing administrators. Some roles that were clearly defined include charge nurse, primary bedside nurse, secondary bedside nurse, “environmental nurse” for supplies and restocking, monitor in the anteroom, and several support persons for specimen transport, workflow management, etc. Before the start of the shift, a team huddle was done to review previous events and provide assessment of patient’s condition. Whenever patient transport is needed between departments, security staff escorts the patient, logging the date, time and persons involved in the transfer.
Note: For the full report of our rapid review on this topic, please send us an email at nightingale.research.solutions@gmail.com