Consistently Exploring Nurse Staffing and Neurocritical Care Unit Turnover.

ABSTRACT: BACKGROUND: Staffing models within nursing units have long been a hot topic of discussion. The COVID-19 pandemic exacerbated this discussion by straining the national nursing environment and workforce. Before the pandemic, the neuroscience intensive care unit (NSICU) primarily used an acuity-adjusted staffing model and aimed for a nurse-to-patient ratio of 1:1.5. During and after the pandemic, the NSICU was forced to primarily use a centralized staffing model because of the increased turnover in the hospital at large and a rise in patient census. METHODS : Unit census data in an NSICU were tracked before, during, and after the pandemic alongside utilization of a centralized staffing model in the hospital at large. RESULTS : During this time, the NSICU saw a statistically significant increase in average nurse-to-patient ratio and incidences of both floating and tripled assignments. The NSICU simultaneously saw a 180% increase in nursing turnover. CONCLUSION : Although we cannot prove that a centralized staffing model is directly responsible for higher nursing turnover, its utilization led to greater incidence of poor staffing-reflected in deviation from the nurse-to-patient ratio goal of the unit. Nurse staffing concerns play a large role in nurse satisfaction in the workforce: staffing shortages have been described both as a precursor to and as a consequence of increased nursing turnover.

Exploring Plan of Care Communication With a Multidisciplinary Rounding Plan to Nursing Care Plans.

ABSTRACT: BACKGROUND: The nursing care plan (NCP) was developed approximately 100 years ago as a teaching tool for nursing students. Our neuroscience intensive care unit (NSICU) uses a multidisciplinary rounding plan (MDRP) that may provide more relevant and up-to-date information than the standard NCP. METHODS: In this prospective single-blind randomized pilot study, we examined nurses' abilities to respond to 7 clinical scenarios common to the NSICU. The NCPs and MDRPs from 70 patients were randomly assigned to 14 nurses (10 per nurse) who answered each of the 7 questions using only data from an NCP or data from an MDR. RESULTS: The MDRP mean score of 4.51 (1.50) correct answers was statistically significantly higher than the NCP mean score of 0.31 (0.71) correct answer (P < .0001). CONCLUSION: The MDRP was designed to address the modern-day communication needs of NSICU staff by leveraging technological advances. Data from this study suggest that the MDRP may have advantages over the NCP in providing contextually relevant information. Additional research is warranted to develop the MDRP as a replacement for the NCP in the NSICU setting.

Distributions and Reference Ranges for Automated Pupillometer Values in Neurocritical Care Patients.

BACKGROUND: Automated pupillometry is becoming widely accepted as an objective measure of pupillary function, especially in neurocritical care units. Normative reference values and thresholds to denote a significant change are necessary for integrating automated pupillometry into practice. OBJECTIVE: Providing point estimates of normal ranges for pupillometry data will help clinicians intuit meaning from these data that will drive clinical interventions. METHODS: This study used a planned descriptive analysis using data from a multicenter registry including automated pupillometry assessments in 2140 subjects from 3 US hospitals collected during a 3-year period. RESULTS: We provide a comprehensive list of admission pupillometry data. Our data demonstrate significant differences in pupillary values for Neurological Pupil Index, latency, and constriction velocity when stratified by age, sex, or severity of illness defined by the Glasgow Coma Scale score. CONCLUSION: This study provides a greater understanding of expected distributions for automated pupillometry values in a wide range of neurocritical care populations.