Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units

Abstract

To provide an analysis of the scope of nursing practice and inter-professional role responsibility for ventilatory decision-making in Australian and New Zealand (ANZ) intensive care units (ICU). Currently, little empirical data describe nurses' role in decision-making for ventilation and its weaning. Delineation of roles and responsibilities for ventilatory practices vary according to unit structure, staffing and skill-mix, patient case-mix and unit leadership models. Self-administered questionnaire sent to nurse managers of eligible ICUs within ANZ. Results. Survey responses were available from 54/180 ICUs. The majority (71%) of responding ICUs were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4.7 in Australia and 4.2 in NZ, with 69% (IQR: 47-80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse-to-patient ratio for ventilated patients with 71% reporting a 1:2 nurse-to-patient ratio for non- ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision-making. Decisions to change ventilator settings, including FiO(2) (91%, 95% CI: 80-97), ventilator rate (65%, 95% CI: 51-77) and pressure support adjustment (57%, 95% CI: 43-71), were made independently by nurses. The results of this survey suggest, within the ANZ context, nurses participate actively in ventilation and weaning decisions. In addition, the results support an association between the education profile and skill-mix of nurses and the level of collaborative practice in ICU. Relevance to clinical practice. Mechanical ventilation may result in significant complications if not applied appropriately. Collaborative practice that encourages nursing input into decision-making may improve patient outcomes and reduce complications.