Just five paediatric intensive care units met their recommended nurse staffing levels for this type of service in 2014, according to an NHS-funded audit across the UK.
The three-year review of 34 PICUs by academics at the University of Leeds and University of Leicester also found a high reliance on temporary nurses – up to 25% of staff – by units in London.
Those behind the report said these two findings made for “sobering reading” and called for closer working with commissioners and more innovative approaches to recruitment and retention from managers.
“It is difficult to achieve continuity of care when staffing is so stretched and the complexity of care required by the children admitted to intensive care continues to rise”
A snapshot survey in November 2014 showed only 14% of units had a nursing establishment which met the standard of at least seven whole-time equivalent qualified nurses required per one critical care bed.
The professional standard is set by the Paediatric Intensive Care Society (PICS), which previously required just under 6.5 WTE nurse establishment per critical care bed as a minimum.
The 2014 survey found 10 units in total were meeting this old target in 2014, which was worse than the year before when 13 units reached it.
Meanwhile, recommended nurse staffing levels per shift were met in around 60% of cases, probably due to use of temporary workers to fill gaps in nursing establishment.
These standards, also set by PICS, require a nurse to patient ratio ranging from 0.5:1 to 2:1 according to patient dependency.
Bank and agency workers in PICUs at London trusts accounted for around 25% of staff across nearly all the timeframes the snapshot survey looked at in November – during the week and weekend, and at day and night.
This compared to just 5% for PICUs based outside of London in the rest of the UK.
However, despite these findings, the Paediatric Intensive Care Audit Network report noted mortality rates in children’s intensive care units across the country remained very low.
Of the 19,700 admissions of children PICUs in 2014, less than 4% died after being admitted.
“Innovative solutions are required to maintain a high quality work force”
The report also noted that, while there had been no significant increase in the number of children admitted to PICUs over the last three years, children were spending longer in them.
Beds were occupied for around 131,000 days in 2014 – an increase of about 2,700 bed days, compared with 2013.
Professor Liz Draper, from the University of Leicester, said: “Paediatric intensive care units continue to have difficulty achieving the PICS nursing standards.
“It is difficult to achieve continuity of care and the use of a designated nurse when staffing is so stretched and the complexity of care required by the children admitted to intensive care continues to rise,” she said.
“Problems with the recruitment and retention of nursing staff in this stressful environment are growing and innovative solutions are required to maintain a high quality work force, such as self-rostering and more flexible working for staff with families and other dependents,” she added.