A national survey of Australian Intensive Care Unit (ICU) liaison nurse (LN) services

Abstract

Background The Intensive Care Unit (ICU) Liaison Nurses (LNs) emerged as a member of the multidisciplinary team to: assist in the transition of patients from ICU to the ward, respond to the deteriorating patient in an appropriate and timely manner, and in some instances act as an integral member of Rapid Response Teams (RRT). Purpose To identify the common core aspects and diversity within the ICU LN role across Australia and to determine whether the ICU LN hours of operation and the participation in MET teams has any impact on the activities undertaken by the ICU LN. Method This descriptive survey of 152 Australian ICUs was conducted in April 2010. The Advanced Practice Nurse (APN) framework was used to develop the survey instrument, which comprised of four scales, education (5 items), collaboration (6 items), practice (8 items) research and quality (6 items) and a number of demographic questions. Descriptive statistics (mean, standard deviation (SD), median, interquartile ranges (IQR) and frequency) were used to summarise the data. Student's t-tests and Pearson's correlations were used to test the hypotheses. Results Surveys were received from 113 hospitals (55 metropolitan, 58 regional): a 74% response rate. ICU LN services operated in 31 (27%) of these hospitals. LN services tended to operate in larger hospitals with higher ICU admission rates. The median weekly hours of operation was 56 (IQR 30; range 7-157), delivered by a median of 1.4 (IQR 0.9; range 0.0-4.2) Full Time Equivalent (FTE) staff. The median weekly patient visits made by the LN was 25 (IQR 44; range 2-145). The LN was reported to be a member of the Medical Emergency Team (MET) in 17 (68%) of the 25 hospitals that provided both MET and ICU LN services. The ICU LN activities were grouped under four key Advanced Practice Nurse (APN) domains: education, collaboration, practice and research/quality. Mean scale scores were calculated for each APN domain. The ICU LN reported being involved in activities associated with all four APN domains, and more frequently they were involved in education and expert practice during their daily work. Neither the presence of a MET nor the weekly operational hours of the LN service significantly affected the key activities undertaken by ICU LNs (education, collaboration, practice, research and quality). Conclusion Whilst many hospitals across Australia have introduced an ICU LN service, the staffing, hours of service, job classifications, reporting lines, referral processes and APN activities undertaken by the ICU LN, vary between hospitals, highlighting the diverse nature of ICU LN services across Australia.