COVID-19: critical care nurse-to-patient ratio redefined as 2:1 for second wave

Temporary guidelines aim to avoid ICU nurses being ‘spread too thinly’

Temporary guidelines aim to avoid repeat of first wave where ICU nurses were ‘spread too thinly’

Nursing staff in intensive care unit
Picture: PA

Critical care nurse-to-patient ratios must be at least 2:1 under revised guidance on coping with a surge in COVID-19 cases.

Agreed between NHS England and leading nursing organisations, the guidelines are the latest development in COVID-19 emergency measures that have seen a relaxation of the normal 1:1 ratio in intensive care.

Need for non-specialist support in the ICU to achieve 1:1 care

The document – which has yet to be published – states there should be at least one trained critical care nurse for two patients, supported by a non-ICU nurse, British Association of Critical Care Nurses (BACCN) chair Nicki Credland explained.

‘That is one ICU nurse to two patients with a non-ICU nurse or operating department practitioner as well so it is still 1:1 nursing, it is just not 1:1 nursing with an ICU nurse,’ she said.

‘The alternative is to turn patients away and we can’t do that.’

New guidance overturns staffing ratios used in first stages of the pandemic

The document updates guidelines on staffing ratios published at the start of the pandemic which sanctioned a team approach with critical care nurses put in charge of groups of patients supported by colleagues who were not experts in the field.

Ms Credland said the revised guidance followed concerns critical care nurses were spread too thinly, harming patients’ care.

‘Back in March we developed a surge ICU nurse staffing strategy and in some cases we ended up with one ICU nurse to four or even six patients,’ she said.

‘We’ve seen substandard patient care in areas with that kind of staffing capacity and a massive amount of psychological trauma in ICU nurses,’ she added.

Ratios will revert to 1:1 after the COVID-19 surge has passed

She said NHS England had decided to revisit nursing ratios in collaboration with leading nursing bodies including the BACCN, RCN and the Critical Care National Network Nurse Leads Forum.

Ms Credland also stressed that critical care teams are committed to this being a temporary change and they would revert to 1:1 ratios once the COVID-19 surge had passed.

The full document is expected to be published this week.

In other news