(100) Creative Staffing Solutions for Nursing Shortages in PICU While Improving Quality of Care

Introduction: Since the COVID 19 pandemic Pediatric Intensive Care Units (PICU) across the U.S. have significant critical care nursing shortages. This can result in an inability to admit patients, requiring denials, transfers to other facilities and potentially adversely impact quality of care due to sub-optimal nurse patient ratios. This quality improvement endeavor performed at a large quaternary care PICU with high critical care nursing vacancy rates aimed to address the problem using creative nursing recruitment and onboarding approaches while measuring quality of care and outcomes.

Methods: The hospital, a 48-beds quaternary care PICU had a critical care RN vacancy rate exceeding 75% and turnover rate of 37% in January 2023. This led to declining admissions and a large drop in patient census. Nursing leadership adopted an innovative approach to address this challenge and rapidly change culture. Key interventions: 1) decreasing application-to-offer timeframe 2) revising the PICU nurse orientation including social connections, enhancing inclusivity and 3) partnership between nursing and physicians to create and implement just-in-time education. Clinical quality metrics including nosocomial infection rates, falls, IV infiltration, pressure ulcers and hand hygiene were monitored.

Results: Between 2023-24 85 nurses were recruited in 15 months, 69 being new nurse graduates. PICU peak average census (leading indicator) and average midnight census (lagging indicator) increased significantly along with a reduction in incoming transfer denials. Increased PICU capacity accompanied an increase in high acuity patients (p < 0.05) indicating the ability to better meet community needs. Measurable improvements in clinical quality metrics were noted with no serious safety events. Nursing vacancies reduced from 75% to 10% and nurse turnover from 37% to 12.5% indicating improvements in recruitment and retention.

Conclusions: 1) Reducing on-boarding time, pre-employment engagement and just-in-time education are effective interventions to achieve culture change and rapid improvement in nursing recruitment and retention.
2) This approach is accompanied by improvements in several clinical quality indicators.
3) This experience has the potential for being replicated in other pediatric and adult critical care units.