World Federation of Critical Care Nurses 2019 Position Statement : Provision of a critical care nursing workforce

Background
Due to changes in critical care worldwide, the World Federation of Critical Care Nurses Board of Directors commissioned a review of its 2005 Declaration of Buenos Aires: Position Statement on the Provision of a Critical Care Nursing Workforce.

Aim
To provide international recommendations to inform and assist critical care nursing associations, health services, governments, and other interested stakeholders in the development and provision of an appropriate critical care nursing workforce.

Methods
An international review group was established, comprised of critical care nurse clinicians, leaders, and researchers. A literature search was undertaken, which informed the revision of the 2005 Declaration, which is contained in the 2019 Position Statement.

Position
The position is supported by six central principles, and is comprised of eight key statements: A critical care unit should have a dedicated nurse leader; Each shift should have at least one registered nurse (RN) designated as the team leader; The majority of RNs providing patient care should hold a recognized post-registration qualification or certification in critical care; Critical care RN staffing should be assessed on a shift-by-shift basis according to patient acuity, the staffing profile, and unit need; An additional critical care RN, not counted in RN-to-patient ratios or allocated a patient load, may provide additional hands-on assistance in patient care, and coordinate other patient-related activities; Support staff (such as nursing and allied health assistants, nursing aides, and care assistants) should work only under the direct supervision of a critical care RN, and never in place of a critical care RN; Where institutionally supported, and in accordance with local legislation, a critical care RN may provide expert critical care consultancy; A critical care unit should be staffed to provide at least one senior nurse, who holds a recognized post-registration critical care qualification or certification, and ideally further qualifications in education.