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Lack of nurses with ICU skills puts patients at risk
Tamar Kahn - Science and Health Editor, Business Day
2008-01-25

Hospitals are grappling with an acute shortage of nurses with the skills to work in intensive care units (ICUs), posing risks to patients and driving up health-care costs, according to a national audit reported in the latest SA Medical Journal. Our nurses are tired, often not healthy, and plagued by discontent and low morale, wrote the researchers.

The quality of the training and continuing medical education is dubious, (and) there are no effective recruitment and retention strategies , they said. The audit, covering all of SA's public and private hospitals, was commissioned by the Critical Care Society of SA, representing doctors and nurses working in ICU and high-care units. High-care units are specialised facilities for patients who have been in intensive care, and are also used to try and prevent a patient deteriorating to the point where they need ICU services. The researchers found three-quarters of the 448 ICU nursing managers were ICU-trained nurses, but only a quarter of the nurses working under them had specialised training. A mere 3,8% of the nurses were trained as neonatal ICU nurses to care for very young babies. Only 5,7% of ICU nurses had more than 20 years' experience. There were 4168 ICU and high-care beds in SA serviced by 4584 professional nurses, or 1,1 nurse a bed. 

Using an ideal ratio of three nurses a bed, the authors calculated SA had an ICU nurse deficit nearly 8000. The gold standard should be 6,7 nurses an ICU bed and 3,9 a high-care bed. The shortage of ICU nurses forced many staff to work dangerously long hours, said study co-author Juan Scribante, head of research at the anaesthetics department, University of the Witwatersrand (Wits). 

If you work excess hours, you are tired and make mistakes. That is a huge concern for patients. Co-author Prof Sats Bhagwanjee, who heads Wits' anaesthetics department, said there was an inadequate supply of graduates from nursing colleges and poor retention strategies in the public and private sector. They found wide provincial disparities in services available to patients. The majority of ICU beds were in Gauteng, KwaZulu-Natal and Western Cape. More ICU and high-care beds were in the private sector (2385), serving a fifth of the population, than in the public sector (1783). Many high-care units were in general wards, which increased the risk of death and disease.

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