A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B.

Objective: The urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital's patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates. Methods: We performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI. Results: Despite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer (p = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p = 0.075). Conclusion: In the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion.

Factors influencing the choice of the first ward: comparison between newly qualified nurses and managers.

We had given a questionnaire to a group of newly qualified nurses and nursing managers responsible for their recruitment with the purpose of understanding the factors influencing the choice of the first ward. For this study, 45 nurses and 10 nursing managers had been recruited. There are 19 factors that influence the choice of the first ward: the most important is the kind of patient, both, nursing managers and newly qualified nurses agreed about, while about the other factors there were different answers. Reflecting on the choice factors may help hospitals to better understand the expectations of the newly qualified nurses and start improving projects to make even the less requested wards more attractive; it can also help the faculty to reflect about the academic curriculum that mostly influences the professional future of the students.

Competence of Romanian nurses after their first six months in Italy: a descriptive study.

AIMS AND OBJECTIVES: Aims of this study were to describe (a) the Romanian nurses' reasons for emigration and the difficulties experienced in the first six months of integration, (b) their perception of the level of professional independence and competence gained in the first six months of working and (c) the strategies that either facilitated or impeded their development of professional independence at a teaching hospital. BACKGROUND: The international recruitment of nursing staff is a strategy adopted by the Italian State to confront nursing shortages. Although the critical aspects and the opportunities available have been reported for many years, little has been written about the professional autonomy perceived by these nurses six months after their placement in the host country. DESIGN: A descriptive study involving Romanian nurses working at the Udine University Training Hospital (Italy) was used. METHODS: The participants were interviewed using anonymous questionnaires, which contained eight open and 20 closed questions. With their consent, the interview was done in the ward and took on average 45 minutes (from 30-60 minutes). Given a choice of language to use by the bilingual researcher, half the participants chose Romanian. RESULTS: The small, homogenous group of Romanian nurses used as the sample and employed at the University Training Hospital, felt satisfied (in the areas of culture/placement/integration) and recorded similar facilitating factors and obstacles as those documented by other authors. By the sixth month following placement they felt they had a sufficient level of autonomy, but this was not the case in many skills, which are an essential part of Italian nursing. CONCLUSIONS: The expectations of the hospitals involved in international recruitment are higher than the Romanian nurses can guarantee, especially in the first six months. Integration obviously needs substantial investment, less 'red-tape' and a longer period of time for adjustment. RELEVANCE TO CLINICAL PRACTICE: It is necessary to help and support the placement of these nurses into the Italian workforce with programmes where their practical work is supervised by permanent trained staff, allowing them to develop autonomy and ensuring an optimal standard of nursing care for the patients. It would be necessary to continue these programmes for more than six months.