Transcript
Chapter 1: High-Acuity Nursing
Chapter Summary
In today’s health care environment, skyrocketing costs and a shortage of acute care beds require that clinicians make decisions about where in the hospital, or in which hospital, acutely ill patients receive the most efficient and cost-effective care. Step-down, or intermediate, care units may provide for an efficient distribution of resources for patients whose acute illness requires less monitoring equipment and staffing than is provided in a high-acuity ICU. Clinicians can use established guidelines in the decision-making process to determine which patients would benefit most from receiving care in an ICU.
Multiple factors contribute to a shortage of nurses and high-acuity beds. Because the appropriate RN–patient ratios have not been established, alternative patient care delivery models and reliance on UAP have been used. Hospitals that achieve Magnet accreditation are a potential solution to the nursing shortage, as these hospitals act like magnets to recruit and retain professional nurses. A shortage of high-acuity beds has created dilemmas regarding who should receive these costly resources.
Nurses who care for acutely ill patients must be able to use technology in the caring process and still recognize its limitations. Equipment must be used to enhance, not take the place of, a nurse’s personal knowledge, observation skills, and senses. The skilled nurse who practices in a high-acuity setting must be able to bridge the gap between complex technology and the art of caring.
The promotion of healthy work environments will improve nurse satisfaction, enhance retention, and lead to excellent patient outcomes. Nurses are susceptible to burnout. The symptoms of burnout may be cognitive, psychological, physiologic, and behavioral in nature. Strategies useful in limiting or buffering job-related stressors include comprehensive unit orientation, continuing education for stress reduction, and the development of strong social support groups.
Errors in health care are in the public eye. The culture of many hospitals is moving from one of blame to one of caring and support. This has led to an increase in the reporting of medical errors. Technology has been introduced to decrease errors. While many of these technologies have been successful, the end users must be competent in using them. Adequate staffing, well-educated nurses, and positive nurse–physician relationships have been associated with increased patient safety.
