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Health Care

PICOT is P- Nurse Retention in CCU/Step Down

The role of nurses in patient care is of immense importance because they help the patients and their caregivers in many stages of treatment in hospitals and clinics. It is obvious that nurses have to bear a plethora of challenges in their working lives. Especially the nurses in the CCU/Step Down have to face the severe load of work and emergency situations which might be nerve-breaking. The retention of nurses is a global issue because the working conditions of the CCU/Step Down are almost similar. Turnover rates vary from 15.0% to 44.4% across Canada, the USA, New Zealand, and Australia (Khan et al., 2018). The government of the UK has included nursing in the shortage occupation list by the Department of Health (DH) (Khan et al., 2018). The high turnover in the critical care units has many reasons behind it. A study has found that quality of working life and occupational stress are the top reasons for the intention of nurses to leave their jobs in CCU (Chegini et al., 2019). Even in normal conditions, the retention of nurses in the CCU is vital; however, the onset of COVID-19 has intensified the importance of this matter. Apart from traditional solutions, research has suggested that the empowerment of the caregivers and family members of patients in the CCU might decrease the workload of nurses working (Li et al., 2014). In this way, they might be willing to stay longer in emergency wards. The current research paper tries to offer credible solutions to this important problem through the exploration of scientific studies and peered review literature.

The clinical practice question (CPQ) in the PICOT Format

  1. P- Nurse retention in CCU/Step-Down
  2. I-Incentive, mentorship program, online and offline training and short courses, more leaves, monetary incentives, etc
  3. C- Currently, new hires go through 3 month ICU program, and rotate to go to the step-down unit patient to nurse ratio is 3:1 instead of ICU 2:1.
  4. O- The staff member will stay in CCU for more than 3 year
  5. T- Manage to collect the anonymous survey in 3 months regarding nurse satisfaction and how long nurses are planning to stay in CCU. Moreover, the study would find their grievances and preferences to be helpful in remedial measures.

The previous studies on the subject of nurse retention also offer some credible solutions. The management of the facility might refer to those research articles to solve the issue. At the national level, the government might include CCU/ Step Down nurses in the most needed profession category. At the level of the hospital, customized measures might solve the issue; however, the management must be aware of the coronavirus situation which might curtail the efforts of the administration. On the other hand, the pandemic might significantly increase the workload of nurses. In this case, a study suggested increasing the empowerment of caregivers of patients who belong to the family of the patient (Li et al., 2014).

The development of online learning technologies including Zoom might offer a credible solution in a situation where health care workers want to decrease unnecessary person-to-person contact. The administration of the hospital might conduct an online survey and use the findings to develop a short training course in the current situation. The course might be helpful in relieving the stress of nurses providing critical care. The research has proved that stress and occupational working conditions are among the important reasons why nurses want to quit CCU/ Step Down. It is hoped that a combination of various solutions discussed here would improve the situation and nurses would stay in CCU/ Step Down for three years.


Chegini, Z., Asghari Jafarabadi, M., & Kakemam, E. (2019). Occupational stress, quality of working life and turnover intention amongst nurses. Nursing in Critical Care.

Khan, N., Jackson, D., Stayt, L., & Walthall, H. (2018). Factors influencing nurses’ intentions to leave adult critical care settings. Nursing in Critical Care24(1), 24–32.

Li, H., Liu, Y.-L., Qiu, L., Chen, Q.-L., Wu, J.-B., Chen, L.-L., & Li, N. (2014). Nurses’ Empowerment Scale for ICU patients’ families: an instrument development study. Nursing in Critical Care21(5), e11–e21.



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