|Year : 2017 | Volume
| Issue : 3 | Page : 235-241
Challenges and work crisis facing critical care nurses
Ghada S.K Mahran1, Asmaa A.M Taher1, Nadia M.A Saleh2
1 Department of Critical Care & Emergency Nursing, Faculty of Nursing, Assuit University, Assuit, Egypt
2 Department of Nursing Administration, Faculty of Nursing, Sohag University, Sohag, Egypt
|Date of Submission||28-May-2017|
|Date of Acceptance||30-Jan-2018|
|Date of Web Publication||1-Jun-2018|
Nadia M.A Saleh
Lecturer of Nursing Administration Department, Faculty of Nursing, Sohag University, Sohag
Source of Support: None, Conflict of Interest: None
Background Nursing turnover and shortage are acknowledged as worldwide issues. Therefore, understanding the challenges that faces the nurses and overcome these challenges is essential in retaining them. Study was aimed to assess the challenges and work crisis facing critical care nurses.
Subjects and Methods Research design : A descriptive, exploratory, qualitative research design was used.
Setting Trauma ICU, ICC unit, and general ICU at Assiut University Hospital.
Subjects (45) staff nurses.
Tool of data collection A structured interview questionnaire consists of two parts; Personal characteristics and Challenges and Crisis Questionnaire Assessment tool through 2016.
Results About 68.88% of the study sample were aged between 20 and 30 years and were married, and 44.44% had experience of 1–5 years. 88.88% of them reported large number of patients in ICUs, 82.22% reported increase in workload and increased numbers of night shifts. 97.8% fear of the possibility of infection from patients and 73.3%, have conflict between nurses and doctors. (84.5%) recorded working atmosphere filled with tension and stress. (93.3%) have sense of responsibility for some of the equipment and materials, and some critical cases. (91.1%) had family life at risk.
Conclusion Admission of a large number of patients in the ICUs, increase in workload, exposure means for family life owing to choose the profession of nursing, and stability in family life disorder because of increased working hours and long shift were the most common challenges facing nurses.
Recommended Training programs should be provided to develop coping skills among staff, and nurses’ mangers should take active steps to create positive work environment.
Keywords: challenges, critical care nurse, ICU, work crisis
|How to cite this article:|
Mahran GS, Taher AA, Saleh NM. Challenges and work crisis facing critical care nurses. Egypt Nurs J 2017;14:235-41
| Introduction|| |
Nurses play an integral role in the healthcare field, providing care to patients and filling leadership roles at hospitals, health systems, and other organizations. However, being a nurse is associated with big challenges (Kelly, 2015).
Although nursing has a wide scope, the demand for this profession is decreasing as nurses do not get appropriate financial compensation and respect according to their duties, which are much more difficult as compared with doctors and physicians. They constantly deal with patients and spend unbearable long hours but are still not compensated as much as they deserve. The compensation and respect that nurses receive related to the responsibilities of the job should be increased (Mebrouk 2008; Gondwe et al., 2011).
Another challenge that nurses face is the violent behavior of patients in the hospital. Many patients are difficult to communicate and can be violent at times. This is why this profession is highly demanding and quite stressful at times. Workplace violence is a serious problem among nurses. Most of the time, patients and other health staff are the major sources of violence against nurses (Gazzaz, 2009).
Shortage of nurses is a worldwide problem. Nowadays, with the increase in health services costs, hospitals are facing crisis in managing shortage in nursing staff. This is because hospitals are investing more in advanced medical technologies rather than focusing on maintaining proper staff. Owing to shortage in nursing staff, the nurse-to-patient ratio is still unbalanced. The number of patients is increasing by time, and there is an acute shortage of nurses to attend the patients (Cortese, 2012; Lamadah and Sayed, 2014).
As nurses are responsible for care of the patients, they are always at risk of acquiring diseases that these patients have. Many times, even the healthiest of the nurses may acquire these illnesses. It is imperative for the nurses to take care of themselves by fortifying themselves with the proper vitamins/nutrition, keeping up to date with their vaccinations, and staying physically fit.
In today’s changing healthcare landscape, relatives of critically ill patients are taking a more active, hands-on role in the care and recovery of their loved ones. Relatives of the critically ill patients not only provide patients with psychological support during critical illness but they themselves also benefit from enhanced connectivity (Rippin, 2011).
High-quality communication with the relatives is the backbone of the art and science of nursing (Lind et al., 2011). It has a significant effect on patient’s well-being as well as the quality of nursing care outcome of nursing care (Bailey et al., 2010) and is related to family’s overall satisfaction with the patient’s care (Ramsey, 2012). The maintenance of high nurse-family communication also depends on the nurse and the patients’ family. The quality of care in ICU has been shown to be affected by many factors including inadequate nursing staff, much nursing records, long waiting time, and lack of Specialized nurse (Rose et al., 2008).
From the researchers’ experience during training the nursing students and direct contact with nurses, they noticed that nurses’ face many challenges and problems related to their work such as work overload, lack of respect from others, and exposure to some hazards and diseases, which in turn affects the quality of care. Moreover, this kind of research has not been performed before.
| Aim|| |
This study aimed to assess the challenges and work crisis facing critical care nurses at Assuit University Hospitals.
What are challenges and work crisis facing nurses working in ICUs at Assuit University Hospitals?
| Patients and methods|| |
A descriptive, exploratory, qualitative research design was used in this study.
The study was conducted in trauma ICU, ICC unit, and general ICU at Assuit University Hospitals.
A convenient sample of 45 nurses who participated in patient care and had more than 1-year clinical experience working in selected setting were included in the study (n=15 staff nurse from each unit).
Tools of data collection
A structured interview questionnaire for nurses consisting of two parts was used.
Personal characteristics data sheet: it included items related to sex, age, educational level, years of experience in nursing, and social status.
Challenges and Crisis Questionnaire Assessment Tool: it was modified by researchers after reviewing the available literatures (Ragab, 2008). It encompassed 32 items to assess the challenges and crisis facing critical care nurses and includes workload (five items), stress (seven items), supportive materials (five items), responsibility (five items), role conflict (four items), and challenges related to patient’s family (six items) to assess challenges facing critical care nurses in ICUs. This tool was translated into Arabic by the researchers.
The response to each item ranged from 1 (yes) to 0 (no).
| Operational design|| |
After reviewing the available literatures concerning the topic of the study, modification of the study tool was done, and validity was performed. This phase took about 3 months from February to April 2016.
A pilot study was fulfilled to test feasibility and reliability of the study tool. It was carried out on 10 staff nurses selected from units not included in the study. Data collected from the pilot study were analyzed, reviewed, and used in making necessary modifications before the final application of the study tool. The duration of this phase took ∼1 month through April 2016. The reliability of the study tool was 0.89.
After ensuring the clarity of the tool, the actual data collection was carried out on staff nurses by personal interview with each participant in the study. Each interview took ∼15 min, which started with clarifying the aim of the study and interpretation if needed. The whole duration of data collection took ∼2 months from May to June 2016.
- Permission was obtained from the head of ICUs and from the director of Assuit University Hospitals to conduct the study.
- Participants received explanation about the purpose and confidentiality of the study.
- In addition, participants were informed about their right to accept or refuse participation in this study through informed consent.
Data entry and statistical analysis were done using SPSS 19.0 statistical software package (IBM Corp., Released 2010, IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp.). Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables. Pearson’s correlation analysis was used for assessment of the inter-relationships among quantitative variables. Statistical significance was considered at P value less than 0.05.
| Results|| |
[Table 1] shows that ∼68.88% of the study sample is in the age between 20 and 30 years and is married. Regarding the job in ICU, 64.44% of the study sample worked as a bedside nurse. Moreover, 44.44% had experience of 1–5 years.
|Table 1 Distribution of personal characteristics data of studied nurses (n=45)|
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[Table 2] shows that ∼88.88% of the study sample reported large number of patients in ICUs, 82.22% each mentioned increase in workload and increased numbers of night shifts as workload challenges faced by them.
[Table 3] reveals that most of the study sample reported dealing with severe medical conditions and chronic diseases with little hope of recovery, the fear of the possibility of infection from patients, dealing with patients with different values and beliefs, lack of appreciation for his/her efforts, and conflict between nurses and doctors (86.7, 97.8, 62.2, 68.9, and 73.3%, respectively) as psychological challenges.
[Table 4] reveals that the highest percentage of the study sample recorded working atmosphere filled with tension and stress, lack of appropriate offices of nursing, and unavailability of chance to introduce your abilities and skills (84.5, 77.8, and 60%, respectively) as technical support challenges.
[Table 5] reveals that majority of the study sample (93.3%) reported sense of responsibility for some of the equipment and materials, medicines, and supplies and sense of responsibility for some critical cases as sense of responsibility challenges.
|Table 5 Distribution of sense of responsibility challenges of studied nurses|
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[Table 6] reveals that highest percent of the study sample (91.1%) had family life at risk by the choice of nursing profession and had instability in family life owing to increased working hours and night shift. Moreover, ∼86.7% reported working time and long shift as contrary to family and 75.5% received professional training and knowledge of how to handle critical situations.
[Table 7] reveals that ∼80% reported there are written regulations on visit dates and duration and 37.77% reported good preparation is made to provide the patients’ family with the necessary information and to educate them, and there are adequate and suitable waiting spaces for patients’ family.
[Table 8] revealed that there were significant statistical differences between workload challenges with technical support and role conflict (P=0.023 and 0.010, respectively). Moreover, there was a significant statistical difference between technical support and sense of responsibility (P=0.008).
|Table 8 Correlation between workload challenges, psychological load, technical support, sense of responsibility, role conflict, and family care challenges (n=45)|
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| Discussion|| |
To decrease the challenges which face nurses in the hospitals should be work on improve the relationships with physicians and colleagues, work demands, organizational policies, and acknowledgment of competence. The present study was implemented in an attempt to assess the challenges and work crisis facing critical care nurses at Assuit University Hospitals. The study participants were 45 staff nurses at trauma ICU, ICC unit, and general ICU (15 from each unit).
The present study states that the highest percentages of participants’ aged from 20 to 30 years old, had experience in the ICUs ranged from 1 to 5 years, were married, and had the job as a bedside nurse. All of them were female.
The present study revealed that regarding workload challenges, most participants reported an increase in workload owing to large number of patients in the ICUs and increased number of night shifts for them ([Table 2]). This result agreed with Ragab (2008), who reported that long hours of working among nurses and the increased frequency of night shift owing to nurses’ absenteeism lead to suffering from double load of professional and family responsibilities. Alwin (2013) reported that, the nurse’s job face a lot of trouble because of long periods of work in relation to both their body and mind, where a lot of responsibility in a short time. This result may be owing to the decrease in the actual number of staff nurses at ICUs, which leads to increased work overload and increased frequencies of night shift to cover shortages. Wong (2012) cited that National Nurses United is working on implementing federal legislation to establish nationwide nurse ratio guidelines.
The current study revealed that as regarding to psychological load, the highest percentages of participants agreed to the fear of the possibility of infection from patients, dealing with severe medical conditions and emergency diseases with little hope of recovery, and conflict between nurses and doctors, with no conflict between nurses themselves ([Table 3]). These results are in agreement with Alwin (2013), who reported that nurses responsible for patient care are at risk of developing various diseases, so the nurses should take care of themselves by fortifying with proper nutrition and vaccinations, by staying physically fit, and by following health and safety policies. These results may be due to patients admitted to the ICUs very critical cases, bad behavior of some of the doctors toward nurses, and some nurses being not committed to infection control precautions.
The current study revealed that regarding supportive materials, working atmosphere filled with tension and stress, lack of appropriate offices of nursing staff, and unavailability of chance to introduce ones abilities and skills as challenges ([Table 4]). These results are in line with Ford (2012), who reported the lack of support for staff who raises concerns about the quality of care, and the biggest problem was either lack of compassion in some nursing staff or pressure and lack of support for ward and community managers. Moreover, Gondwe et al. (2011) cited that lack of adequate formal ICUs training for nursing staff is one of their major challenges. These results may be owing to specialists training programs in ICUs were not enough and conflict and stress in working condition because of work overload and shortages.
Our study shows that regarding the sense of responsibility, most participants agreed of a sense of responsibility for some of the equipment and materials, medicines, and supplies and for some critical cases ([Table 5]). These results were in consistent with Pietersen (2005), who reported that more than half of study sample was not satisfied with their organization, and they were not committed to their responsibility. These results may be owing to nursed being highly committed of their responsibilities to material and supplies because they have the official custody and having emotional feeling toward critical cases.
The current study revealed that regarding role conflict challenges [Table 6], most of the participants stated that family life is risked by the choice of nursing profession, working time and long shift are contrary to family, and the job leads to instability in family life owing to increased working hours and night shift. This result was in agreement with Ragab (2008), who reported that, nurses who spend long time in their job have difficulty in fulfilling their family responsibilities, and Bowman and Allen (1990), as they stated that the source of stress for female is a conflict between family responsibilities and work. Moreover, Kandolin (1993) explained that the major responsibilities at home for female to their family and pursuing a full-time work lead to physical and emotional difficult. These results may be owing to the community view toward the nursing profession, especially in Upper Egypt, and leaving a family long time during the work period leads to neglect of some of the duties toward the family, which leads to increased family problems.
The current study revealed that regarding care of the patient’s family challenges, most participants agreed that there are written regulations on visit dates and duration, and about two-thirds of them reported disagreement regarding there are regulations written that provide for the continued existence of the family next to the patient, there are adequate and suitable waiting spaces for patients family, and there is enough time to meet the patient’s family demands [Table 7]. These results were consistent with Gondwe et al. (2011), who reported that at the ICUs, there is information available about the visiting hours. This result may owing to the presence of explanatory plates with the instructions of the required visit at the entrance of ICUs and lack of suitable waiting spaces owing to lack of available space.
The current study revealed that there were significant statistical differences between workload challenges with technical support and role conflict [Table 8]. This result may be owing to the fact that there were effects of supportive materials on workload and role conflict.
| Conclusion|| |
The most common challenges and crisis facing critical care nurses were large number of patients in ICUs, work overload, fear of the possibility of infection from patients, working atmosphere filled with tension and stress, limited exposure means toward family life owing to choosing the profession of nursing, stability in family life disorder because of increased working hours and long shift, and waiting places not suitable and sufficient for family satisfaction.
- Training programs should be provided to develop staff skills for problem solving and coping strategies for stress and facing challenges.
- Nurses’ managers should take active steps to create positive work environment.
- Nurses’ mangers should create opportunities for nursing staff to identify the problems and allow their participation in solving them.
- Hospital managers should be committed toward empowering nursing staff.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]