The work itself, respect as a professional, and finding meaning
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Intentional debriefs throughout complex cases to reduce the spread of false or unproductive info |
Ongoing transparency around unit level and organizational level decision making that impacts frontline staff |
Swift and transparent addressing of unit-based issues by management, particularly when it comes to staff safety/respect issues with patients and families |
Regular debriefing with support from a bioethics team/consultation both during and after difficult cases |
Thoughtful patient assignments taking into account the nurses’ previous shift experience |
Transparency in assignment selection |
Benefits and compensation
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Proper compensation for extra hours worked (particularly for charge/clinical support team members who regularly leave late) |
Focus on fostering unit level relationships (among nurses as well as among nurses and the interdisciplinary team) |
Recognition of critical care as a unique group of nurses when it comes to compensation, for example, providing increased compensation, more mental health days, formal mental health check-ins |
Initiate compensation based retention strategies for nurses in order to keep talent within the organization |
Separation as preservation
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Ensuring nurses get breaks during their shifts |
Ensure staffing levels are sufficient so there is a reduced need for staff to work overtime. |
Provide the opportunity for, and reduce a culture of guilt around, taking mental health days |
Make designated mental health days 12 h instead of 8 h in order to benefit the frontline staff who have to most exposure to stress/trauma |
Ability to ask for an assignment change or break from a specific assignment |
Provide an on-site 24/h wellness space where nurses can take a break when needed |
Identity
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Ensure nurses only float to other critical care areas rather than throughout the hospital |
Implement a resource nursing team to assist with staffing needs throughout the hospital |
Acknowledge that critical care work and workflow is different from other areas of the hospital by ensuring consultation with critical care nurses prior to implementation of hospital-wide policies and interventions |
Investment in growth and development
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Provide opportunities for task rotation (e.g., opportunities to engage in project work) |
Provide opportunities for advanced training at the bedside (e.g., certify on Continuous Renal Replacement Therapy (CRRT) and Extracorporeal Membrane Oxygenation (ECMO) |
Provide opportunities for professional development and advancement |