The critical care nursing workforce in Western Cape hospitals - a descriptive survey

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South African Journal of Critical Care

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Health and Medical Publishing Group


University of Cape Town

Background: A global shortage of registered nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical care nurses (CCNs) especially are in great demand and short supply. Purpose: The purpose of this study was to quantify the nursing workforce and compare it with requirements of critical care units (CCUs) in hospitals of the Western Cape province as at 1 January 2005, and to quantify potential recruits from nursing education institutions. Design: A descriptive survey conducted on site in CCUs of the private and public sector hospitals of the Western Cape, using a structured questionnaire. Results: Data were obtained from questionnaires (96.5% return rate) from 77 of the 80 CCUs surveyed in 35 hospitals (12 public; 23 private). Intensive care units (ICUs) and high-care units (HCUs) were classified in the questionnaire. Findings revealed: 39 adult ICUs (12; 27), 2 paediatric ICUs (public), 14 neonatal ICUs (4; 10), 13 adult HCUs (11, 2), 1 paediatric HCU (public), 3 neonatal HCUs (public) and 5 high-dependency units (HDUs) for adults (public), with 720 functional unit beds in total (359; 361). A registered nurse/ventilated patient ratio of 1:1 was used in 5.26% of public sector units but in all private sector units. Of the 768 nurses of all categories in public sector units 118 (15.4%) were trained CCNs and 289 were RNs (37.6%). In private sector units 204 (38.1%) of 535 nurses were trained CCNs and 204 (38.1%) were RNs. According to a consensus-driven method developed in Australia to measure the required number of ICU nurses, the Western Cape has a deficit of 72% and 80%RNs respectively in public and private sector CCUs, amounting to an actual total shortage of 2 711 RNs. Data from 7 educational institutions revealed that during 2004, 300 undergraduate nurses and 80 postgraduate CCNs graduated. Conclusion: The current supply of nurses does not meet the needs of CCUs in the Western Cape, and the number of educators and clinical mentors is inadequate.