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Abstract |
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• Objectives To describe issues of workforce, compensation, and care specific to critical care units and nurses who work in them.
• Methods The American Association of Critical-Care Nurses conducted a survey of randomly selected facilities with critical care units in the United States. Facilities were solicited via e-mail to respond to a survey on the World Wide Web and provide information on operations, evaluations, nursing staff reimbursement and incentives, staffing, and quality indicators. Responding facilities also provided contact information for units in the facilities. Those units were surveyed about operations, acuity systems, staffing, policies on visitation and end-of-life care, administrative structure, documentation, certification, professional advancement, vacancy/floating, staff satisfaction, orientation, association membership, wages, advanced practice nursing, and quality indicators.
• Results The initial response rate (120 of 658 eligible facilities) was 18.2%, and 300 of 576 solicited units nominated by the facilities responded, yielding a 52.1% response rate for the second phase.
• Conclusions These survey data define the scope and intensity of services offered and provide more specific figures about staffing issues and unit practices than has been accessible before. Healthcare providers may use this information for benchmarking purposes, especially for instances in which the tables provide data for each particular type of critical care unit.
| This AACN survey provides benchmarks against which hospitals and critical care units can compare care.
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The types of data collected in this survey are not available elsewhere. Only recently have data from regional or national studies specific to critical care begun to be published. Halpern et al1 provided information on the numbers of beds in intensive care units (ICUs) in the United States and the costs of intensive care relative to national health expenses and the gross domestic product. Information is not available, however, about the severity of the shortage of nurses in critical care units, statistics related to quality of care in critical care units, or other important factors that may vary from one type of unit to another. A search of the Cumulative Index to Nursing and Allied Health Literature with the terms "nurse," "critical care," and "statistics" and limited to the years 2000 to 2005 yielded only articles from other countries, about a single state, or articles about nurses and clinical issues. When the search was limited to US journals, only 72 references were found.
Although many groups gather and publish comprehensive statistics on hospitals and nurses in the aggregate, few separate out the data for critical care units and critical care nurses. Reports of hospital statistics that include nursing issues and patient information tend to include only data combined across all units. Rarely are the data presented according to the specific characteristics of critical care units. It is therefore difficult to ascertain if the issues and events reported are similar in frequency in all types of units. For example, staffing statistics have not been analyzed by type of unit; no one has compared data from ICUs versus data from telemetry units versus data from postanesthesia care units (PACUs). Until now, these data have not been available on a national basis—only within individual hospitals.
Among the many variables included in the AACN national critical care survey were hospital characteristics, unit and staff demographics, certification, formal and continuing education, leadership, decision making, patients’ outcomes, and staffing.
In addition to traditional ICUs, the study included other areas within the hospital where acutely and critically ill patients are cared for, such as progressive care, telemetry, and step-down units. Data on these types of units, their nurses, and their patients are even scarcer because these units are still relatively new developments. PACUs were also included in the survey because they are an important part of the critical care continuum.
Planning for this survey began in the summer of 2003. Data were collected from facilities in the fall of 2003 and from units in the spring of 2004.
In this article, we present part of a more comprehensive report available at www.aacn.org or by calling 800-899-2226. The goal of this initial article is to present the profile of the facilities and units surveyed. Specific areas of the findings will be covered in more depth in future articles.
| A profile of facilities and units surveyed is presented here. A more complete report is available at www.aacn.org.
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Method |
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Facility Phase. The survey team purchased a list of hospitals that met the survey criteria from a nationally recognized healthcare organization. Criteria for invitation to participate in the survey included the presence of one or more of the following types of units: ICUs (of any type), step-down units, progressive care units, telemetry units, PACUs, and other units where nursing care is provided for acutely and critically ill patients.
Hospitals with fewer than 50 licensed beds were omitted from the sample. Although these facilities may be listed as having an ICU, many have only 1 or 2 beds designated for stabilization of critically ill patients, and those beds are not always available. Eligible hospitals were then divided up into strata by number of beds (50–100; 101–200; 201–300; 301–500, and 
501) and were randomly sampled across the strata. Specifically, quotas were placed on the number of hospitals contacted within various strata; that is, quotas were placed on hospitals with 50 to 100 operating beds, 101 to 200 operating beds, and so on. This process allowed the inclusion of more large hospitals and fewer smaller hospitals than would have been included if proportional sampling had been used; in proportional sampling, small hospitals would have predominated, preventing analyses of differences in hospitals with different numbers of beds.
A total of 749 facilities were included in the sample and invited to participate. During the course of the invitation and follow-up process, 91 facilities were deemed ineligible, resulting in a final eligible sample of 658 facilities. Of those eligible facilities, 120 (18.2%) participated. When the data were tabulated, they were weighted to ensure that the range of facility sizes reflected the range of sizes of US hospitals in general. Both the unweighted and weighted profiles of the facilities are listed in Table 1
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Instrument
Two instruments were used: one questionnaire for the facility data and another for the unit data. Respondents to both the facility and unit questionnaires were instructed to report data for a full 12-month period, preferably from their most recently completed fiscal year.
Several steps were taken to improve the reliability and validity of the instruments. Experts in questionnaire design and in critical care nursing and critical care management designed and tested the instruments. After development of the questionnaires, experts in nursing management reviewed them for correct use of terms and generalizability across settings. Because the questionnaires were converted to pages on the World Wide Web, AACN staff and volunteers tested flow, handling of potential responses, and ease of use.
Facility Survey. The facility questionnaire was administered online, and representatives for the invited facilities were e-mailed an invitation with a link to the survey instrument. The questions were presented in a Web format, preprogrammed to allow respondent-selected options, when appropriate, or free text, when necessary. Facility representatives who did not have e-mail or who preferred a paper form were provided with a questionnaire on paper. The survey included questions on the following topics: demographics about operations (14 questions), evaluations (4 questions), nursing staff reimbursement and incentives (7 questions), staffing (9 questions), quality indicators (4 questions), and information on critical care units and contact information for critical care unit managers to solicit responses to the unit survey.
Unit Survey. Also administered online (with a paper option available upon request), the unit survey contained questions on a wide array of topics: operations (10 questions), acuity systems (3 questions), staffing (8 questions), policies on visitation and end-of-life care (3 questions), administrative structure (13 questions), documentation (3 questions), certification (6 questions), professional advancement (5 questions), vacancy/floating (11 questions), staff satisfaction (2 questions), orientation (8 questions), association membership (3 questions), wages or registered nurses (RNs; 1 question), advanced practice nursing (8 questions), and quality indicators (5 questions).
Procedure
After the facilities were randomly selected, a contact person equivalent to the critical care director was determined for each facility, and contact information was collected. E-mail invitations were sent to these individuals to encourage them to go to the Web site where the facility questionnaire was available. As facility questionnaires were completed and critical care units and managers were specified, invitations were sent to the unit contacts to ask them to complete the second phase, the unit questionnaire.
Follow-up was implemented by using a number of options. A full-time AACN employee was dedicated to follow up with nonrespondents in both phases of the survey. Special care was taken to follow up by e-mail and telephone to encourage participation or to determine the reason for nonresponse. Nonresponse was a bigger factor in the facility phase of the survey than in the unit phase. Ultimately, the sample of facility responders was compared with the group of nonresponders to ensure that the sample of responders was representative of the randomized pool of hospitals. The research team validated that the responder facilities did not differ significantly from the nonresponder facilities in terms of available data such as number of beds or geographic distribution.
Output from the completed questionnaires was reviewed for consistency with expected responses, and clarification was sought for outliers. Extreme outliers in individual item responses that could not be verified were removed so as not to alter reported means.
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Results |
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TopAbstractMethodResultsConclusionREFERENCE |
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. US hospitals in general and the weighted data include fewer large hospitals than actually participated in the study. Academic and urban hospitals tend to be larger than other facilities. Therefore, their proportions were reduced accordingly when the number of large hospitals in the weighted sample was reduced. The weighted profile of facilities is the profile that should be considered when the facility findings are examined, because the findings reflect this breakdown. According to this profile, the majority of facilities represented in the data are general medical and surgical hospitals (91%), nongovernment, not-for-profit organizations (74%), from a variety of settings, with a mean of 217 operating beds and 258 licensed beds. Where sample sizes allowed, differences between the various facility types and sizes are indicated.
Operations.
Not all respondents provided information on inpatient admissions, excluding newborns but including neonatal and "swing" admissions and readmissions (swing beds are those that can be used to provide either acute or long-term care depending on the needs of the community or patients). Participating institutions had a mean of almost 13 000 admissions per year (Table 2). More than two thirds of respondents did not have data available on cost per patient day or were unable to answer the question. Of those responding, the mean cost per patient day was $1883 (Table 2). The mean cost per adjusted discharge was $7333.
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At the time of the survey, only 5% of responding hospitals had been designated Magnet nursing services through the American Nurses Credentialing Center’s Magnet program. Seventy-nine percent of facilities did not have Magnet-designated services, but almost half of these (44%) said that they planned to apply for such status in the next 3 years. Mainly larger hospitals planned to apply (Table 3).
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| Five percent of responding hospitals had Magnet-designated nursing services, although almost half planned to apply.
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Incentives. Most hospitals offered tuition reimbursement both to RNs for academic programs (83%) and to students in educational programs to become RNs (85%). Almost half of the facilities surveyed (44%) had implemented professional development and advancement programs for bedside nurses, primarily clinical ladder systems. A further 12% had programs in development.
| Almost half had nursing development programs such as a clinical ladder.
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Staffing. About half of the responding institutions (52%) provided information on numbers of budgeted RN full-time equivalent (FTE) positions. Among those, the numbers of total budgeted RN FTEs ranged up to 1000 or more; most facilities (64%) had fewer than 300 positions. The median number of budgeted RN FTE positions was 214, and the mean was 332. The total number of unfilled budgeted RN FTE positions was up to 100 or more; most hospitals (64%) had fewer than 30 unfilled positions. The median and mean numbers of unfilled positions were 21 and 36, respectively. The means for total and unfilled budgeted positions were slightly higher than the medians because some hospitals had many positions. The mean vacancy rate, calculated by dividing the mean number of unfilled positions (36) by the mean number of budgeted RN positions (332), was 10.8%.
Among the 51 facilities that provided information, the total number of RN staff who had terminated employment during a 12-month period (including voluntary and involuntary termination) was up to 150 or more. The median number of terminations was 31, and the mean number was 53 (the mean is higher because a few hospitals had high termination levels). Respondent hospitals reported a mean turnover rate of 11.8%. The mean turnover rate was calculated by dividing the mean number of terminations (53) by the mean number of RNs on the payroll (449).
| Hospitals reported a nursing vacancy rate of 10.8% and a turnover rate of 11.8%.
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Almost two thirds of respondents did not have data available on the number of days needed to fill a vacant RN position or were unable to answer the question. Answers varied among those who responded, but it took a mean of 59 days (median 54 days) to fill a vacancy (Figure 1).
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| Most hospitals (64%) did not have a collective bargaining unit representing their nursing staff.
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Participating Units
Critical care units were defined as any unit in which acute and critically ill patients received care. In this survey, the 3 prevalent types of critical care units, ICUs, PACUs, and progressive care units, were studied (Table 4). From the 120 responding facilities, 300 critical care units participated in the survey. A little more than half of the units in this study were traditional ICUs. The unit results were not weighted to reflect hospitals nationwide, because the proportions of critical care units across US hospitals in general are not well known. Therefore, we caution that the total results for each question are skewed to the activities of the more dominant units in the sample. (For example, the total results are somewhat more representative of the activities of recovery room/PACUs, medical-surgical ICUs, and combined intensive/coronary care units and less representative of the activities of trauma units and burn ICUs). Differences between ICUs (total) and progressive care units (total) and PACUs specifically are discussed throughout this section, because their sample sizes were large enough for categorical analysis. The sample sizes for the other individual units were too small for such analysis.
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shows relationships between the types of units in a hospital and the unit’s size. Of note, in this table, smaller units (12–29 operating beds) are predominantly ICUs.
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Operations.
Almost half (46%) of the critical care units in the study had fewer than 15 operating beds; the largest concentration of units (30% of units) had 10 to 14 beds. Overall, the mean unit size was 19 operating beds (median 16 beds; Figure 2).
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More than three quarters of units did not provide information on readmissions, an important indicator of quality of care. Perhaps the respondent did not have access to the information or that information was not collected in the unit. Of the units for which information was provided, 38% had had no readmissions within 48 hours during the preceding 12-month period. Among the few remaining respondents, the number of readmissions within 48 hours varied widely from 1 to 50 or more during a 12-month period. The median number of readmissions was 4, and the mean was 16 (the mean was skewed high because a few critical care units had high numbers of readmissions).
Among the 59% of respondents who provided information, numbers of inpatient days for their units were as high as 10 000 or more in a 12-month period. The median number of inpatient days was 3708, and the mean was 4808 (the mean was skewed slightly higher than the median because some units had very large numbers of inpatient days).
Seventy percent of respondents provided information on the mean length of stay in their units. In most critical care units (74%), the length of stay was between 2 and 5 days. The longest stays were in larger critical care units (20% of patients in the largest units stayed for 11 days versus 2% in the smaller units) and in urban hospitals (which are more likely to have the larger critical care units; Table 6). Table 6 also shows how numbers of operating beds, admissions, and inpatient days varied depending on unit size and hospital setting. Naturally, larger units had more operating beds, admissions, and inpatient days; mean values among smaller and larger units are shown in the table.
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Acuity Systems. Forty-two percent of critical care units in the study used a formal acuity system. Formal acuity systems were more prevalent in the largest hospitals (>500 beds) and urban hospitals (which tended to be the larger ones). A wide variety of systems were in place. In about 7 in 10 critical care units surveyed, respondents had seen an increase in patients’ acuity in the preceding year or had perceived that acuity at the time of patients’ transfer or discharge was higher than it had been 1 year earlier.
Respondents from the larger units (12 or more operating beds) and urban/suburban hospitals were most likely to have noticed these changes in acuity (although urban facilities were less likely than suburban facilities to have experienced higher-acuity transfers/discharges). Increases in patients’ acuity were reported equally in ICUs, progressive care units, and PACUs. But, progressive care units (and ICUs, directionally) were more likely than PACUs to see patients being transferred or discharged with higher acuity (Table 7).
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Respondents were asked which factors they considered in determining the number of nurses needed for their basic staffing plans. Of the 4 factors listed in the survey, the most commonly considered factor (by 88% of respondents) was the expected patient census. The need for specialized skills (eg, balloon pumps, dialysis) and the skill mix of the staff ranked next in importance. A formal acuity system had the lowest priority.
The few PACUs were less inclined than ICUs and progressive care units to select any of the 4 factors. Smaller units (up to 29 operating beds) were more likely than large units to take into account the need for specialized skills. Formal acuity systems were more of a priority to urban hospitals, where these systems were more established, than to suburban/rural facilities. Still, acuity systems had the lowest priority even among urban hospitals (Table 8).
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| Most respondents thought that the staffing had not been optimal up to 25% of the time in terms of the match between patients’ acuity and the nurses’ skill level or mix.
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Nine percent of critical care units participating in the study had recently been required to close beds for more than 30 days because of insufficient numbers of RNs. This finding was consistent among all types and sizes of units.
Overall, most critical care units (71%) had a policy that patients being transported out of the unit must be accompanied by a unit nurse. The number of transports of patients out of the unit for tests or procedures varied considerably and depended on the unit.
Respondents were asked what they used when they needed to adjust staffing to manage sudden or emergency admissions or sudden increases in patients’ acuity. Of the 7 options given in the survey, the most commonly used strategies (used by 70% of units or more) were calling in regular staff RNs on their days off, calling in regular staff RNs early, and juggling current RN staff to make do. Borrowing ("floating") RNs from other critical care areas was the next-most-used alternative (by just more than half of the units). Floating RNs from other noncritical areas was the least favored option.
The predominant way that units in the study managed floating among their staff was via cluster unit floating; staff were required to float, but in a designated unit only (55% of units). Among the remaining units, 2 practices were equally prevalent: in open units (23%), staff were required to float to any unit within the facility; in closed units (19%), staff were not required to float outside of their unit. The strategies used to manage sudden or emergency situations or to manage floating varied considerably by type of unit and hospital. Progressive care units were less likely than ICUs and PACUs to use on-call systems and were more likely to float RNs from non–critical care areas.
ICUs and progressive care units were more likely than PACUs to use several different approaches for managing sudden admissions or increases in patients’ acuity. They were more likely than PACUs to call in regular staff RNs on their days off, to float RNs from other critical care areas, or to use agency nurses. The reasons were not addressed in the survey. This finding may be linked to the fact that the few PACU nurses in the study used other strategies that were not listed among the options for that item. Or, perhaps PACUs did not adjust staffing for sudden situations to the same degree that ICUs and progressive care units did.
Similarly, rural hospitals were less likely than urban or suburban hospitals to use many of the strategies listed. Again, the reasons for this finding were not addressed in the survey. Perhaps fewer rural hospitals than urban/suburban hospitals had increases in the acuity of patients or in the number of patients requiring long-term chronic critical care. Or, perhaps rural hospitals used other approaches that were not listed in the questionnaire. Or, perhaps they did not need to make staffing adjustments to the same degree as urban and suburban hospitals did.
Visitation Policies. In the survey, respondents were asked what their unit’s family visitation policy was and were given 3 alternatives to select from, with an option to write in another response (these other responses were quite diverse). The 3 family visitation policies given were as follows: open on a scheduled basis only, open except for rounds and/or changes in shift reports, and open at all times.
Family visitation policies varied considerably by unit type and size. Units that were open on a scheduled basis only (eg, hourly, every 2 hours for a specified time, or some other schedule) were almost always ICUs or progressive care units; very few respondents from PACUs reported having this policy (Figure 4).
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| Most intensive care units were open for family visitation on a scheduled basis only; larger units were more likely to be open all the time.
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Policies varied even within unit type. Most ICUs were open on a scheduled basis only (44%). But, ICUs also commonly had a policy of being open except for rounds and/or changes in shift reports (31%). The percentage of progressive care units that were open at all times (36%) did not differ significantly from the percentage that were open on a scheduled basis only (34%). Not surprisingly, most (84%) of the few PACUs in this study used some other family visitation policy than the 3 just listed (Figure 4). Smaller units (<30 operating beds) were more likely than large units to have a policy of being open except for rounds and/or changes in shift reports. Larger units (30 beds) were more likely than other units to be open at all times.
End-of-Life Care. Respondents were also asked what policies they initiated for managing patients when the goals of care changed from aggressive care to comfort care. Again, they were given 3 alternatives to select from, with an option to write in another response (these other responses varied widely). The 3 comfort care policies that they were given were palliative care standards, end-of-life care standards, and hospice services in the unit.
Comfort care policies varied considerably by type of unit. Progressive care units (86%) and ICUs (75%) were most likely to have comfort care policies. Among both progressive care units and ICUs that did have policies, palliative care standards and end-of-life care standards were equally prevalent. Progressive care units were more likely than ICUs to also implement hospice services in the units (Figure 5). Most PACUs (71%) did not have comfort care standards or those policies were not applicable to their units. Those that did have policies tended to use policies that differed from the policies listed in the questionnaire.
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Overall, about 1 in 4 critical care units reported using some type of end-of-life protocol, and this finding was consistent across most types of units and facilities studied. The one exception was among urban hospitals, where an end-of-life protocol was somewhat more prevalent than it was in suburban facilities.
Administrative Structure. Slightly more than half of the units (55%) surveyed had formalized shared governance through written bylaws and staff-directed committees, mostly at a facility-wide level. Units with a formalized structure were more likely to be PACUs (particularly when compared with progressive care units), rural hospitals, and smaller units with fewer than 30 operating beds.
Documentation. Overall, 42% of the critical care units surveyed used an electronic documentation system. These units were more likely to be ICUs and progressive care units, smaller hospitals (up to 300 operating beds), suburban hospitals, and nongovernment, not-for-profit hospitals. The majority of critical care nurses (83%) could access the Internet in their units as a resource for their nursing practice. Nurses in large hospitals (>500 operating beds), mid-sized hospitals (201–300 beds), and mid-sized units (12–29 beds) had even greater Internet access than did other nurses.
Recognition. Nursing recognition awards were presented in 84% of the units in the study. The awards were often presented on multiple levels, usually including the facility level (62% of respondents), but nurses were also commonly awarded at the nursing department (41%) and unit levels (39%).
Nursing recognition awards had a variety of forms, depending on what nurses were being recognized for. Public acknowledgment was an often-used reward across different activities. Many facilities rewarded a particular achievement in several ways. As indicated in Table 9,
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30 beds and urban hospitals.) Similarly, about 8 in 10 facilities surveyed offered no financial support for association membership, and this finding was consistent across all types and sizes of facilities. Professional Advancement. Most of the hospitals in the study (84%) offered financial support to nurses for continuing education. This support most often was in the form of paid registration or paid time off for local or regional/national meetings (in about two thirds of units).
Progressive care nurses were less likely than ICU or PACU nurses to receive support for continuing education. The same was true for nurses in government nonfederal hospitals, compared with nurses in non-government not-for-profit facilities. Small to mid-sized units (
29 operating beds) were more likely than large units to offer paid time off for meetings.
Filling Vacancies. The total number of budgeted RN FTE positions in the critical care units in the recent months before the survey was up to 50 or more (mean 34 positions). The total number of open/unfilled budgeted RN FTE positions (excluding contract) was up to 10 or more. But 40% of units had minimal numbers of unfilled positions. Specifically, 19% had no unfilled positions and 21% had 1 or 2 open positions. On average, units had 4 open/unfilled positions.
The mean vacancy rate was 11.8%. This rate was slightly higher than the 10.8% vacancy rate reported facility-wide. The vacancy rate was calculated by dividing the mean number of unfilled positions (4) by the mean total number of budgeted RN positions (34).
The actual total number of RNs (individuals) in the units was up to 70 or more; about half of the units had between 20 and 49 RNs. The mean number of individuals working in the units was 38. Total numbers of RN FTEs working in the units seemed lower than the total number of RNs working there; this finding was not surprising because of the number of part-time staff (fewer units had 50 RN FTEs). But these numbers should be viewed with some discretion because 20% of the units did not provide information on RN FTEs. Thirty-four percent of units used RN FTEs that were contract staff (including travelers and local external agencies).
Slightly more than half of the units surveyed (52%) reported that their numbers of budgeted RN positions had not changed since the previous 12-month period. Twenty-seven percent of units, however, had experienced an increase in the number of budgeted positions; these were more likely in suburban facilities than in urban/rural ones. The number of budgeted RN positions had decreased among 17% of units, particularly units in larger hospitals (the number of positions in smaller hospitals was more likely to have remained unchanged).
The turnover rates for ICUs, progressive care units, and PACUs were 11.2%, 13.3%, and 6.5%, respectively. Turnover rates were determined by dividing the mean number of terminations by the mean number of RNs on the unit’s payroll.
More than half of the respondents did not have data available on the number of days required to fill a vacant RN position in their units or were unable to answer the question. Among those who provided information, it took a mean of 66 days to fill a vacant post, although some units required more than 120 days. Progressive care units (mean 90 days), followed by ICUs (mean 62 days), took the longest to fill vacancies. PACUs were able to fill vacant RN positions quickly in comparison (mean 33 days).
Orientation Programs.
About 8 in 10 units in the study reported having clinical rotations of not-yet-licensed students in their units and hiring newly licensed RNs (Table 10).
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). ICUs and progressive care units and larger hospitals (>200 beds) were more likely to have orientation programs in place for newly licensed RNs. Almost all units, including recovery room/PACUs, had standardized orientation programs for newly hired experienced RNs. But larger hospitals were more likely to have individualized components for each experienced nurse.
The orientation programs for newly licensed RNs range varied considerably in length; some exceeded 120 days. The median length was 60 days, and the mean length was 80 days (the mean was skewed higher by a few facilities that had lengthy programs). The longest orientation programs were more likely to be run by ICUs; a higher proportion of progressive care units than ICUs had programs that lasted only 30 to 59 days. (Many of the few PACUs in this study did not provide information, making any comparisons difficult.)
Orientation programs for newly hired experienced RNs were shorter than such programs for newly licensed RNs. Some programs lasted more than 60 days; more than one third of programs lasted between 15 and 30 days. The mean duration of an orientation program was 45 days. Again, the longest programs were more likely to be conducted by ICUs and also PACUs; a higher proportion of progressive care units had programs that lasted 30 days or less. Larger facilities (>200 operating beds) and urban and rural hospitals were also more likely than other hospitals to run longer programs for newly hired experienced RNs.
Wages. Survey respondents reported that the mean hourly wage of RNs employed in the unit at entry level was $21. The entry-level wage paid most often was $18 to $19 per hour (27% of units). With 10 years of experience, the mean hourly wage of RNs increased to $27 (with most nurses earning between $22 and $29).
Wage rates were the same among nurses who worked in ICUs, progressive care units, and recovery rooms/PACUs. Government nonfederal hospitals paid higher wages than did nongovernment, not-for-profit institutions. Hospitals with 201 to 300 operating beds paid the lowest wages.
Entry-level wages were the same among small and large units and among urban, suburban, and rural hospitals. However, more of a wage discrepancy was apparent among experienced nurses. With 10 years of experience, RNs in large units earned more than did those in the smallest units (<12 beds). Experienced RNs in urban and suburban facilities earned higher wages than did those in rural hospitals.
Advanced Practice Nursing.
Forty-two percent of critical care units surveyed had hospital-employed clinical nurse specialists allocated to their units. In almost all cases, one clinical nurse specialist was assigned to the unit. Far fewer units (16%) had been allocated hospital-employed nurse practitioners, especially smaller units. It was more often the larger units (30 operating beds) that were assigned nurse practitioners. The number of nurse practitioners assigned to a unit varied among the small number of units that had them.
A greater proportion of ICUs and progressive care units than PACUs had clinical nurse specialists assigned to them. Units in larger hospitals (>300 operating beds), urban hospitals, and academic medical centers (which tended to be larger), and government nonfederal facilities were more likely than units in other institutions to have a clinical nurse specialist. We found no significant relationship between the size of a unit and the presence of a clinical nurse specialist.
Most clinical nurse specialists earned an hourly wage at entry level of between $24 and $34, for a mean wage of $29 per hour. With 10 years of experience, the mean hourly wage for clinical nurse specialists had increased to $34 (with wages mostly concentrated between $26 and $34 per hour). The number of respondents providing information about nurse practitioners’ wages was too small for analysis.
| Almost half of the units had a clinical nurse specialist allocated to their unit, whereas only 16% had been allocated nurse practitioners.
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Conclusion |
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This article offers a broad overview of the findings, and additional articles are planned that will focus more closely on specific areas of the findings, for example, the similarities and differences we validated between ICUs and progressive care units.
The full report of f indings from the AACN national critical care survey is available through AACN at www.aacn.org or by calling 800-899-2226.
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ACKNOWLEDGMENTS |
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To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.
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REFERENCE |
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TopAbstractMethodResultsConclusionREFERENCE |
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When critically appraising this issue’s AJCC journal club article, "American Association of Critical-Care Nurses’ National Survey of Facilities and Units Providing Critical Care," consider the questions and discussion points listed below.
Study Synopsis: This study reports on the findings of AACN’s national critical care survey, which was developed to provide information focusing on critical care nursing, including issues related to workforce, compensation, and care issues specific to critical care units and nurses. Descriptive survey information was obtained from 300 critical care units of 120 hospitals nationwide. Participants completed facility and unit survey questionnaires that assessed information on operations, staffing, quality indicators, acuity systems, administrative structure, and other aspects of nursing practice. Responding facilities include academic and general medical and surgical hospitals in urban, suburban, and rural settings with from 50 to more than 500 beds. The results of the survey provide important information on acute and critical care nursing practice including staffing, documentation systems, shared governance, wages, and nursing recognition awards; unit characteristics include orientation programs, family visitation policies, end-of-life protocols, and characteristics of patients such as length of stay and acuity levels. The results of the national survey provide data on facilities and units serving critically ill patients that were not previously known. Additionally, the survey results offer important information on critical care practices that can be used for benchmarking purposes.
Information From the Authors: Karin Kirchhoff, RN, PhD, lead author of this journal club article, provided additional information about the study. She relates "AACN was the initiator of this research effort. We developed the topics to be covered and the questions to be used. This paper reports on the major findings of the study."
Kirchhoff adds that the study results have important implications for critical care nursing. She states "The data can be useful for benchmarking. For example, the study provides information on what units are doing about traveling with patients for procedures—whether it is a common practice, and if not, what could we do instead?"
Kirchhoff reports that additional information on the study is available. She relates "The full study report is available from AACN. There are many data tables that provide additional study information." She adds "Another use for the study data is to query the results as issues arise in the unit so that you can see what others might have thought of, for instance with respect to nursing staffing, or what units have in place for EOL [end-of-life] issues."
Implications for Practice: This national survey provides helpful information on facilities and units providing care to critically ill patients. The study findings provide information to institutions as well as to the critical care community on aspects of critical care nursing, unit, and facility practices. Kirchhoff highlights the significance of the national AACN survey and adds "This is the first report of some of these variables by type of unit. Also the inclusion of other units such as PACUs [postanesthesia care units] gives us a better idea of how the patient transitions and what the issues are there."
Journal Club feature commentary is provided by Ruth Kleinpell.
This article has been cited by other articles:
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  C. W. Bryan-Brown and K. Dracup Disentangling The Web Am. J. Crit. Care., January 1, 2006; 15(1): 7 - 9. [Full Text] [PDF]
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