Resea ch A icle
A ac ing nu sing alen o he in ensi e ca e uni : A quali a i e s udy on
how o c ea e an appealing wo k en i onmen
Ra ael-Jesús Fe n´
andez-Cas illo
a,b
, Luis Basco-P ado
c,*
, Ma a Rau ell-To ed`
a
c
a
Depa men o Nu sing, Facul y o Nu sing, Physio he apy and Podia y, Uni e sidad de Se illa, A enzoa S ., 6, 41009 Se illa, Spain
b
In ensi e Ca e Clinical Uni , Uni e si y Hospi al Vi gen Maca ena, D . Fed iani S ., 3, 41009 Se ille, Spain
c
Depa amen d’In e me ia Fonamen al i Clínica, Facul y o Nu sing, Uni e si a de Ba celona, Ca e de la Feixa Lla ga, 08907, L’Hospi ale de Llob ega , Ba celona,
Spain
ARTICLE INFO
Keywo ds:
In ensi e ca e nu sing
Nu sing sho age
P o essional engagemen
Quali a i e s udy
Talen a ac ion
S a ec ui men
ABSTRACT
In oduc ion and objec i e: The global sho age o nu ses who wan o wo k in he in ensi e ca e uni (ICU) is
ala ming, pu ing a isk quali y o ca e and pa ien sa e y. Wi h e o s pu in o engagemen s a egies, op imized
ec ui men p og ammes a e sca ce, speci ically in he ICU se ing. The aim o his s udy is o desc ibe and
explo e ICU nu ses’ opinions on hei wo k mo i a ional ac o s ha in luenced he decision o wo k in he ICU
se ing.
Design: A quali a i e esea ch was unde aken, wi h a desc ip i e explo a o y in e p e a i e app oach, imple-
men ing a QUAL-QUAL design, whe e wo da a collec ion echniques a e used simul aneously and complemen
each o he . Expe ienced ICU nu ses we e in e iewed by ocus g oup, using in-dep h in e iews o no el nu ses.
A empla e con en analysis as desc ibed by he model o B ooks was pe o med.
Se ing: The selec ed popula ion was ec ui ed om 6 di e en public hospi als in Spain.
Findings: A o al o 17 nu ses pa icipa ed in he s udy as we eached da a sa u a ion; se en in he ocus g oup and
en by indi idual in e iews. Fou main hemes eme ged om he analysis di ided in o 13 sub hemes: “ICU
aining and educa ion”, “ aking ca e o he in ensi e ca e ”, “op imized human esou ces managemen ” and
“in insic and ex insic mo i a ional ac o s”.
Conclusion: Nu ses conside ha an a ac i e ICU in e ms o job sa is ac ion is he one ha is commi ed o
quali y con inuous aining p og ammes, welcoming p o essionals wi h well-designed men o ing, and aking
ca e o i s wo ke s by p omo ing eamwo k and wo k-li e balance, bu nou synd ome p e en ion s a egies and
mo i a ion o in ellec ual de elopmen .
Implica ions o clinical p ac ice: The desc ip ion o how o c ea e a ac i e ICUs will help o build s a egies wi h
he aim o ec ui ing alen ed highly quali ied p o essionals who will alle ia e he need o nu ses in he ield,
op imizing he ca e p o ided and gene a ing bene i s in managemen and quali y o ca e.
In oduc ion
Nu sing p ac ice in he in ensi e ca e uni (ICU) equi es ad anced
speci ic aining, gi en he high complexi y o pa ien s and hei asso-
cia e nu sing ca e ac i i ies in a e y sensi i e hospi al se ing [1].
Howe e , ICU aining is no always adequa e, wi h nu ses in some
con ex s being up o 50 % dissa is ied wi h i [2]. These uni s also p e-
sen a g ea emo ional bu den o he p o essionals who wo k in hem
[3,4]. Acco ding o a ecen sys ema ic e iew wi h me a-analysis, 31 %
o ICU nu ses p esen emo ional exhaus ion, which has a signi ican
ela ionship wi h he appea ance o dep ession and pe sonali y ac o s
[5].
Because o his, la ely he e has been e idence no only o a lack o
nu ses who wan o dedica e hemsel es o in ensi e ca e [6], bu also o
he sel -decided edeploymen o p o essionals o o he se ices
conside ed as wi h less wo kload o complexi y [7], wi h an 27 %
p e alence o u no e in en ion wo ldwide [8]. Likewise, new g adu-
a ed nu ses ha e had li le aining in c i ical ca e du ing hei deg ee
[9], eeling li le con iden abou hei abili ies o p o ide ca e in he ICU
and no ensu ing an adequa e gene a ional eplacemen [6]. This is an
issue o g ea impo ance, because op imal s a ing le els in he ICU a e
ela ed o low pa ien mo ali y, nosocomial in ec ion, dec eased
* Co esponding au ho .
E-mail add ess: [email p o ec ed] (L. Basco-P ado).
Con en s lis s a ailable a ScienceDi ec
In ensi e & C i ical Ca e Nu sing
jou nal homepage: www.sciencedi ec .com/jou nal/in ensi e-and-c i ical-ca e-nu sing
h ps://doi.o g/10.1016/j.iccn.2024.103937
Recei ed 27 May 2024; Recei ed in e ised o m 5 Decembe 2024; Accep ed 22 Decembe 2024
INTENS CRIT CARE NUR 87 (2025) 103937
A ailable online 8 Janua y 2025
0964-3397/© 2024 The Au ho (s). Published by Else ie L d. This is an open access a icle unde he CC BY license ( h p://c ea i ecommons.o g/licenses/by/4.0/ ).
hospi al cos s and high nu se and amily sa is ac ion [10].
All o his has been in luenced globally by he COVID-19 pandemic,
whe e ICU nu ses ha e su e ed g ea emo ional s ess ha ing o adap
hemsel es o wa medicine si ua ions [11]. As a esul o his, eme -
gency educa ional p og ams we e also c ea ed o all hose nu ses who
we e eloca ed, enhancing ha a speci ic p o ile is necessa y o wo k in
he ICU [12].
In o de o ha e enough nu ses deli e ing op imal ca e o he
in ensi e ca e pa ien , he concep o “s a engagemen ” i ’s unde s udy
wo ldwide, due o high a es o u no e e en o new g adua ed nu ses
[13]. Wo k engagemen o ICU nu ses is posi i ely associa ed wi h
ag eeableness, conscien iousness and emo ional s abili y [14]. On he
o he hand, a ecen su ey shows ha a poo wo k en i onmen and
high wo kload pe cep ion a e associa ed wi h highe in en ion- o-lea e
a es among ICU nu ses in Eu ope [15].
As a o emen ioned, he e a e s udies ha ocus on easons o lea -
ing he p o ession [15], ac o s a ec ing s a sho age [16] o s a egies
o de elop engagemen p og ammes o a oid he in en ion- o-lea e [17]
bu , how do nu ses eel ha we could c ea e an appealing ICU en i-
onmen o alen ed wo ke s? Wi h he aim o ocusing on a ac ing
mo e han in e aining p o essionals, he objec i e o his esea ch is o
desc ibe and explo e he opinions o ICU nu ses in ela ion o pe sonal
wo k mo i a ional ac o s ha in luence he decision o wo k in he
in ensi e ca e en i onmen .
Me hods
Design and se ing
A desc ip i e s udy was conduc ed using an explo a o y in e p e i e
app oach, employing quali a i e me hods o achie e he ou lined
objec i e [18]. The p ojec is buil based on a mul ime hod design,
known as QUAL +QUAL, whe e he e a e wo cen al quali a i e
componen s ha complemen each o he om an induc i e heo e ical
amewo k [19]. In his case, a concu en iangula ion was ca ied ou ,
whe e a single s udy in ol es wo da a collec ion happening a he same
ime, wi h no p io i y o one o e he o he [20]. Fu he mo e, he
objec i e o his ype o design is o alida e he indings gene a ed by
each me hod, h ough e idence p oduced by he o he [21].
Sampling and in o man s’ ec ui men
The s udy was ca ied ou wi h ICU nu ses om 6 egional hospi als
in Spain. The hospi als a e loca ed in he Communi y o Andalucia and
Ca alonia, in he p o inces o Se illa and Ba celona. Each o he
collabo a ing esea che s o he p ojec ca ied ou an in en ional non-
p obabilis ic sampling [22], acco ding o he p ede ined inclusion and
exclusion c i e ia. The inclusion c i e ia we e, o he i s g oup (FG): 1)
nu ses wi h mo e han i e yea s o expe ience in he ICUs. The inclusion
c i e ia o he second g oup (IDI) we e: 1) nu ses wi h mo e han one
yea and less han i e yea s o expe ience in he ICU. The exclusion
c i e ia we e common o bo h g oups: 1) nu ses who do no sign he
in o med consen ; 2) nu ses cu en ly wo king in uni s di e en han
ICUs pe se, such as pos -su gical esusci a ion uni s o in e media e
ca e.
The e is no es ima ed numbe o in e iews ha we e planned o be
ca ied ou , since nu ses we e ec ui ed un il heo e ical da a sa u a ion
occu s, whe e ca ying ou mo e in e iews does no p o ide mo e in-
o ma ion o da a o hose al eady collec ed [23].
Da a collec ion s a egies
Fo bo h g oups, sociodemog aphic da a we e collec ed such as age
(20–30, 31–40, 41–50, 51–60, 61–70), sex (male, woman), wo k ole
(di ec ca e, esea ch, manage , academic o a combina ion o hem),
yea s o ICU expe ience (<1, 1–5, 6–10, 11–15, >15), ma i al s a us
(single, couple, ma ied, sepa a ed/di o ced, widowed), men o ing o
unde g adua e and/o pos g adua e s uden s and scien i ic p oduc ion.
As a da a collec ion ins umen o he i s g oup o in o man s (FG),
he ocus g oup ool was used. The discussion o he opics in a g oup and
he in e ac ion be ween i s membe s, due o he idiosync asies o he
pa icipan s, a o s he en ichmen o he ob ained da a [24]. Fo he
second g oup o in o man s (IDI), in-dep h in e iews will be used. This
is a ool ha is cha ac e ized by a long, uns uc u ed pe sonal con e -
sa ion, in o de o eques in o ma ion on a speci ic opic. Wi h his, we
will ensu e ha he in imacy and indi iduali y o da a collec ion a o s
he since i y o he pa icipan s and, he e o e, op imizes he e aci y o
he esul s [25].
Fo bo h cases, a p e-es ablished in e iew guide was used (Table 1)
based on bibliog aphy and expe consensus. This does no mean ha he
con e sa ion mus ollow a ixed cou se, bu a he ha i is subjec o i s
e olu ion, allowing he eme gence o new opics, wi h he consequen
en ichmen o he ool.
In o de o collec he da a, bo h echniques we e conduc ed ia
Zoom® o acili a e he in o man s’ pa icipa ion. Video call in e iews
a e suppo ed wi h enough e idence o be implemen ed as a eliable ool
in quali a i e da a collec ion compa ed o in-pe son me hods [26]. The
sc een was ideo eco ded du ing he in e iew and no es we e aken on
wha was conside ed impo an o pos e io da a analysis. All he in-
o ma ion was ansc ibed e ba im.
Da a analysis and esea ch igou
A e he ansc ip ion o he eco ded audio, an in e p e i e analysis
was ca ied ou ollowing he Templa e Analysis model p oposed by
B ooks e al. [27]. The ansc ip s o he in e iews, bo h indi idual and
g oup, we e e u ned o ce ain in o man s, o con i m ha hey el
ep esen ed by wha had been ob ained. A e his, o ensu e he quali y
o he analysis, iangula ion was ca ied ou wi h he esea che s [28].
Fo he o ma ion o hemes, codes and subsequen in e p e a ion, he
quali a i e da a managemen so wa e A las. i® e sion 7 was used.
This s udy was conduc ed in acco dance wi h he Consolida ed
C i e ia o Repo ing Quali a i e Resea ch (COREQ) [29] and he
S anda ds o Repo ing Quali a i e Resea ch (SRQR) [30]. The c i e ia
de ined by Lincoln and Guba [31] we e used o epo da a in ela ion o
i s eliabili y, ans e abili y, us wo hiness, and con i mabili y [32].
E hical conside a ions
Pe missions we e ob ained om he heads o he clinical uni s o he
supe iso s o each o he pa icipa ing uni s o de elop he p ojec .
Simila ly, e hical app o al was ob ained om he Resea ch E hics
Commi ee o he pa icipa ing hospi als (in e nal egis a ion numbe :
0255-N-23). All pa icipan s signed an in o med consen p o ided
Table 1
In e iew guide.
1. Why does a nu se choose o wo k in in ensi e ca e?
2. Is i a p e ious aining needed? I so, how mus be his aining pe o med?
3. Do you hink ha in ensi e ca e nu ses a e ecognized, alued and espec ed?
4. Is i impo an o you o ha e an es ablished ole and au onomous
esponsibili ies in he in ensi e ca e uni ?
5. How will you desc ibe he in ellec ual s imula ion and p o essional
de elopmen ha an in ensi e ca e nu se has?
6. A e eaching and lea ning oppo uni ies a p io i y o you in he in ensi e ca e
uni ? ¿
7. Please alk abou wo k en i onmen in he in ensi e ca e uni . How mus i be?
8. How mus be a good human esou ces managemen in he in ensi e ca e uni ?
9. How mus be li e quali y o an in ensi e ca e nu se? Please, desc ibe i .
10. Which ba ie s do in ensi e ca e nu ses o de elop hei wo k in he in ensi e
ca e uni ?
11. Which in e en ions/imp o emen s in e e y ield would help nu ses o wo k in
he in ensi e ca e uni in an e ec i e way?
R.-J. Fe n´
andez-Cas illo e al.
In ensi e & C i ical Ca e Nu sing 87 (2025) 103937
2
digi ally, explaining he objec i e o he s udy and i s de elopmen .
Fu he mo e, pa icipan s we e gua an eed he des uc ion o he sc een
eco dings a e hei audio isual ansc ip ion, p ese ing he ano-
nymi y and con iden iali y o he da a.
Resul s
The o al sample o pa icipan s was comp ised o 17 nu ses, se en
o ming he FG and en o ming pa o he IDI. Rega ding he FG, 50 %
we e women, wi h an a e age o 39 (23 – 51) yea s and 14 (0.5 – 26)
yea s o a e age expe ience in he ICU, while 78 % o he IDI nu ses we e
women, wi h an a e age age o 25 yea s and 1.6 yea s o expe ience in
he ICU. Almos 29 % o he FG nu ses had a pos g adua e deg ee in ICU,
wi h 57 % dedica ing hemsel es o esea ch wo k (pa icipa ing as
esea ch nu ses o collabo a ing wi h da a collec ion), 86 % o eaching
(men o ing bachelo s uden s o wo king as associa e lec u e s) and 29
% o managemen , all combined wi h di ec pa ien ca e. On he o he
hand, he IDI pa icipan s ob ained a pos g adua e deg ee om UCI in
88 % o he cases and only 20 % ca ied ou eaching asks, combined
wi h he ca e ole.
A e da a analysis, a o al o ou hemes common o bo h da a
collec ion echniques and sample o in o man s we e ob ained, sub-
di ided in o 13 sub hemes and g ouped acco ding o ca ego ical ela-
ionship. The lis o hemes and sub hemes, along wi h a g aphic
ep esen a ion o he exis ing ela ionships be ween hem acco ding o
he analysis ca ied ou on he esul s, can be seen in Fig. 1.
In ensi e ca e aining and educa ion
P eg adua e aining
Those in e iewed ag eed on he need o unde g adua e aining
ha mo i a es no ice nu ses o pu sue pos g adua e s udies ela ed o
in ensi e ca e. This is achie ed wi h aining p og ams wi h op imized
cu icula p ac ices, which acili a e access o mas e ’s deg ees ha help
o sha pen hei skills: “Unde g adua e aining should be be e designed,
he e should be mo e and be e o ganized p ac ices which should be mo e
o ien ed owa d job inse ion […] he main ba ie o wo king is he lack o
aining ha mo i a es you and gi es you sel -con idence…” (FG5).
Fu he mo e, no ice nu ses claimed ha aining is wha mainly
emo es ea o wo king in he ICU: “…lack o knowledge leads o ea .
[…] p io quali y aining eassu es when p o iding ca e” (IDI3).
Specialized and con inuous aining
Fo nu ses, he ICU is he pe ec en i onmen o imp o e hei skills
in all ace s o he p o ession, since hey a i m ha i is a place whe e
hey do no s op lea ning, inno a ing and con inuously aining hem-
sel es: “…in he ICU con inuous aining is e y alued, he e a e many
possibili ies o lea n and I lo e being able o do some hing new e e y day”
(IDI2). This would be a undamen al a ac ion ac o , necessa y o wo k
in his se ice and, a he same ime, a mo i a ion o s ay: “I like o lea n,
ad ance and no emain s a ic. The ICU is inno a ion and gi es a lo o op-
po uni ies when i comes o de eloping you sel as a p o essional, you ne e
s op ecycling you sel ” (IDI2).
Taking ca e o he in ensi e ca e
Welcoming he new nu se
Welcoming new pe sonnel o he ICU is some hing o ele ance o
he in e iewees. A wa m welcome by expe ienced nu ses is exp essed
as undamen al, being ecognized as he esponsibili y o e e yone and
no jus he heads o he uni : “…i would be e y in e es ing o old nu ses
o be ained in welcoming he new one, no e e y hing is he esponsibili y o
nu sing manage s, we also ha e o do… explaining hings, helping wi h he
sicke pa ien s… make ha pe son eel suppo ed…“ (GF2). Fu he mo e,
he na a i es epea he need o change he desc ip ion o he ICU as a
closed uni , opening i s doo s o anyone who wan s o wo k in i : “… he
ICU has a epu a ion as a closed uni and ha canno be kep . We could
c ea e imme sion o open-doo days so ha p o essionals who wan can come
see wha he ICU eally is…” (IDI4).
C i ical bu nou
The bu nou synd ome is men ioned by e e an nu ses in hei en-
i e y, mainly because i enhances he in en ion o lea e o nu ses due o
he high wo kloads and he psychological impac o i : “…we don’
usually ha e chill shi s. Colleagues who ha e been he e o many yea s
change hei job because hey a e i ed and ha e physical and psychological
Fig. 1. Themes and sub hemes ex ac ed om he indings and hei ca ego ical ela ionships.
R.-J. Fe n´
andez-Cas illo e al.
In ensi e & C i ical Ca e Nu sing 87 (2025) 103937
3
p oblems” (GF1). Voca ion is no longe enough o wo k in an ICU: he e
a e ala ming discou ses abou he ea ly abandonmen o new nu ses
inco po a ed in o he uni : “…p e iously, people conside ed e i ing in he
ICU… now people in hei 30 s who ha e been in he ICU o less han i e
yea s hinks he same…” (FG3). The solu ion gi en by he majo i y o
pa icipan s is o ewa d his ex a e o wi h ewe hou s o wo k pe
week o by gua an eeing socio- amily concilia ion due o ha dship: “you
could gain in quali y o li e by o e ing mo e ee days o ewe hou s o
wo k… we don’ need mo e sala y, bu mo e hou s a mon h o leisu e o
wi h o spend ime wi h you lo ed ones…” (GF4).
Leade ship and e ical suppo
Ca ing abou he o he is some hing impo an o head nu ses o pay
a en ion o in o de o a ac p o essionals o he ICU: “…i he shi has
been di icul and hey ha e eached ou o me, i hey ha e asked how am I, i
hey ha e old me o alk i I ha e had a bad day…” (FG7). Nu sing man-
age s wan o be seen as a leade and no as a boss, who o e s psycho-
logical suppo and ca es abou humanizing p o essionals’ managemen :
“…due o he idiosync asy o he ICU, we need humanized manage s who
s i e o build a iendly en i onmen a wo k so ha people do no lea e…”
(IDI9).
Op imized human esou ces managemen
Hi ing ained pe sonnel
The speci ici y o he ICU when managing nu sing s a is a conce n
mos equen ly desc ibed by no ice nu ses. The in e iewees exp ess
ha he ICU is ea ed as a gene al uni , wi h i s nega i e consequences
in all aspec s: “… he ICU is ea ed as a gene al wa d, i is no aken in o
accoun ha he people who en e he e mus ha e speci ic knowledge”
(IDI1). The in o man s always sugges o inco po a e p o essionals a e
in-dep h in e iews based on p o iles (a si ua ion ha does no happen
in ou con ex ), which gua an ee excellen ca e deli e y: “…many o he
people who s a s o wo k in he ICU doesn’ ha e any expe ience… in he
end, a comple e ejec ion o wo k in he uni is c ea ed, because i is 12 h o
au hen ic su e ing… and ha ex ends o he es o he s a , making no one
wan o wo k in he ICU” (ID5).
Recompensed men o ship
Wi hou exp essly knowing he exis ence o his concep , he ma-
jo i y o hose in e iewed exp essed in he s udy he need o paid
pe iods o adap a ion o he new job: “ he pe son would en e hei job
much calme because hey know he equipmen , he pa ien s… i would be
much easie and people would da e o come o he ICU mo e” (ENF6).
Fu he mo e, hey p esen his modali y as a help so ha people do no
ejec wo k con ac s when hey ind ou abou hei des ina ion in he
ICU: “… I know colleagues who ha e ejec ed con ac s because hey came o
ICU and since hese con ac s we e e y sho in ime, hey did no ha e ime
o lea n” (GF2).
The eam as a key pa
One o he mos highligh ed posi i e aspec s desc ibed by he in-
e iewees was he possibili y o eal eamwo k, which allows p o es-
sional ul illmen and gene a es an unbea able en i onmen : “I ha e had
a e y good expe ience wi h he physicians and wi h he nu sing assis an s…
e en hough I am new, hey ha e doub ed my abili ies […] communica ion
wi h o he colleagues is much easie han in o he se ices” (IDI4).
Fu he mo e, he ac o being a la ge g oup and eeling suppo ed and
p o ec ed by o he nu ses is essen ial and I ’s e y alued: “wha calms
me mos is ha he e a e a lo o people… you can ha e a ha d ime, bu i ’s
inc edible he amoun o cama ade ie he e is… I had any p oblem and h ee
colleagues appea ed o help…” (FG6).
Ex insic and in insic mo i a ions
Compe ence au onomy and esponsibili y
The main d i ing o ce o ICU nu ses is he ac i i ies independence
and he abili y o make decisions wi h he au onomy ha his equi es.
The in e iewees highligh he a ac i eness o he complexi y o he
ca e p o ided: “you ha e a lo o esponsibili y, bu also au onomy […] in
o he wa ds I el mo e like a echnician han a nu se, I couldn’ make well-
made ca e plans” (FG6). Fu he mo e, hey highligh he need o o ga-
niza ion and s uc u ing o wo k o p o ide quali y ca e: “…knowing well
wha you ha e o do a ac s, gi es you con idence; you don’ go pu ing ou
i es like in o he wa ds, whe e in he end you end o bu n you sel ” (IDI6).
Holis ic ca e
Ano he o he a ac ions o wo king in an ICU is he possibili y o
p o iding nu sing ca e in all possible sphe es, mee ing he needs o he
pa ien s as a whole wi hou o ge ing any: “The ICU is a space whe e
pa ien s a e mo e ulne able, mo e uns able, whe e hey a e much mo e
dependen on he ca e ha we nu ses p o ide… ca e ha mus be as close o
pe ec ion as possible… he ma gin o e o is much smalle and you
accompany pa ien s and amilies o much longe “ (FG1). Wo king in ICU
allows he indi idualiza ion o ca e o i s maximum ex en , knowing he
pa ien s in dep h and pe sonalizing ca e acco ding o hei pas and
cu en con ex : “The ca e ha you gi e o you ICU pa ien , you a e no
going o o be able o gi e hem o him in ano he wa d, you ha e he op-
po uni y o mee him, he is no he pa ien om 430 o 2, he is “John o
Ma ia”, whose daugh e is e y nice, who you know is om a ce ain ci y,
who you know has such a backg ound because she has had ime o ell he
s o y o you, ha you ha e been able o clean him well, ake ca e o all his
hings well, ha you ha e gi en his medica ion on ime…” (ENF8).
In ellec ual s imula ion and p o essional de elopmen
The in o man s desc ibe he ICU as a wa d ha encou ages p og ess
as nu ses, since i equi es a wide ield o knowledge: “I is a uni ha
co e s many hings, le me explain…we can ha e neu oc i ical pa ien s,
kidney pa ien s, sep ic pa ien s, and poli auma ic pa ien s. … I am a e y
cu ious pe son, I like o lea n e e y hing and i I can co e as much opics as
possible, all he be e ” (GF7). Fu he mo e, his p o essional ul illmen
s imula es wo k, despi e he physical and emo ional exhaus ion ha i
may b ing: “The i edness ha I el once I inished an ICU shi , I ha en’ el
anywhe e else; because i ’s wel e hou s a you mos … bu how good you eel
when you go ou because you ha e eally been able o ake ca e in capi al
le e s, ha is no paid o ” (IDI10).
Fea o ou ine
One o he aspec s ha made he pa icipan s choosing o wo k in he
ICU was no wan ing o s agna e in e ms o knowledge: “[ he ICU] does
no ha e ha ou ine pa ha o he wa ds ha e; e e y day and e e y pa ien
a e di e en ” (IDI4). The ac ha i is a place a om he mono ony o
o he uni s, whe e ou ines a e e y es ablished, is an aspec ha nu ses
highligh : “I wasn’ like in o he wa ds, whe e I no iced he mono ony o
each day, he same ype o pa ien … in he ICU i is like e e y day is an
ad en u e and e e y day any hing can happen o you, he cons an ad ena-
line, being awa e all he ime” (GF6).
Social ecogni ion
The concep o he “ICU nu se” ha he es o he people (gene al
popula ion and colleagues) ha e is impo an o ou in e iewees, since
i makes hem eel good and helps hem main ain mo i a ion: “ICU
eams a e well seen om he ou side because hey highly alue he knowledge
we ha e” (FG2). Howe e , hey belie e ha hey should be mo e alued
socially, since he popula ion is unawa e o he wo k o an ICU nu se
un il hey expe ience i : “ hey belie e ha we do he same wo k as a gene al
nu se and we don’ . They associa e i wi h when hey ha e had a amily
membe admi ed o he gene al wa d” (IDI2).
R.-J. Fe n´
andez-Cas illo e al.
In ensi e & C i ical Ca e Nu sing 87 (2025) 103937
4
Discussion
Wi h his a icle we ha e ied o unde s and he needs o nu ses o
eel a ac ed o wo k in an in ensi e ca e uni , gi en he lack o nu ses
in his ield and i s impac on pa ien sa e y, wi h he in en ion o
building e ec i e ec ui men s a egies. The s udy highligh ed ha
a ac ing alen ed nu ses o he ICU is based on emphasizing he need
o es uc u ing unde g adua e aining o build con idence and educe
ea , alongside os e ing con inuous p o essional de elopmen . Key
indings include he ans o ma i e impac o suppo i e onboa ding,
humanized leade ship, and a collabo a i e eam en i onmen . The ICU’s
unique blend o au onomy, holis ic ca e, and in ellec ual s imula ion
we e iden i ied as powe ul mo i a o s o choosing o wo k in he ICU.
Add essing bu nou h ough wo k-li e balance ini ia i es eme ged as
pi o al as well. These insigh s o e a pe spec i e on how o c ea e
sus ainable, high-pe o ming ICU eams, eshaping ec ui men and
e en ion p ac ices in his c i ical heal hca e se ing. Acco ding o his
summa y o indings, a ecen scoping e iew abou ec ui ing nu ses in
he heal h ca e wo k o ce men ions as key ini ia i es some in e en ions
ela ed o leade ship and suppo , ongoing p o essional de elopmen ,
social ecogni ion, op imal wo k en i onmen and lexible scheduling
[33].
As claimed by San ana-Padilla e al. [34], aining p io o p o es-
sional p ac ice in ICU has di ec bene i s o p o essionals and he heal h
sys em. In his sense, ou pa icipan s eel he need o be accompanied a
e e y s ep o hei ICU imme sion, being e y impo an ha , du ing
hese aining pe iods, coaching p og ammes in ICU a e de eloped, wi h
men o ing ha inc eases sa is ac ion, pee suppo and oppo uni ies o
socializa ion [35]. This men o ing, in a ecen sys ema ic e iew, is
ecommended o be de eloped wi h indi idualized one- o-one p og ams
o in he o m o an in e nship [13]. Fu he mo e, he educa ional ole o
e e an s a should be p omo ed, since in-se ice aining is o en
sca ce, he e o e ela ing o a dec ease in he a ac ion o wo k in an
ICU [36]. In his sense, al eady published e idence sugges ha special
a en ion should be paid o new nu ses, since hei wo k engagemen has
shown o be lowe han he olde ones, implemen ing speci ic suppo
p og ams [17].
Nu ses wi h less expe ience poin ha unde g adua e p og ammes
should ake mo e in o accoun he c i ical ca e se ing in di e en o ms.
A ecen quali a i e s udy shows ha acili a ing p ac ices o nu sing
s uden s wi h subsequen men o ing helps o ob ain a double bene i ,
inc easing he eache ’s sel -es eem and hei p o essional ul illmen , as
well as he con idence o he new nu se [37]. Fu he mo e, p omo ing
he igu e o a specialized nu se, such as he ad anced p ac ice nu se,
ensu es an imp o emen in leng h o s ay, mo ali y and pa ien sa is-
ac ion [38].
This op imized aining leads o ano he impo an poin , which is
holis ic pa ien ca e. Those in e iewed a e his ca e oppo uni y as a
g ea a ac ion o he s a , since i is one o he s eng hs o he ICU, as
well as he con inui y o he ca e p o ided, a undamen al axis o ca e o
c i ically ill pa ien s, acco ding o a ecen c oss-sec ional s udy in ou
con ex [39]. Fu he mo e, K ande e al. [40] ag ee wi h ou in-
e iewees ha also he p o ision o humanized in ensi e ca e,
including he amily and he pa ien ’s ision, is o g ea mo i a ion o
nu ses and, he e o e, a good s a egy o a ac ing nu sing alen .
Speci ic alues o he p o ession, such as in ellec ual s imula ion,
compe ence au onomy o p o essional de elopmen , a e conside ed
ex emely impo an by ou pa icipan s. Li e a u e suppo s he high
au onomy o he ICU nu se as a link o adequa e emo ional heal h and
be e eamwo k unc ioning [41]. The p o essional de elopmen ha
ICU nu ses ob ain is essen ial o a ac s a o he en i onmen ac-
co ding o he in o man s as well. Imp o ing nu ses’ ca ee g ow h no
only helps o educe alen loss, bu also educes nu se bu nou , os e s
en husiasm o wo k, and p oduces mo e c ea i e esul s [42]. Wo k-
ela ed alues a e shown o be powe ul mo i a ing elemen s o he
nu ses in e iewed. G´
omez-Salgado e al. [43] ema k ha i he e is no
physical in ol emen o emo ional connec ion, nu ses won’ o e he
quali y o ca e pa ien s equi e; being his one o he main aspec s ha
a ac ICU nu ses o his en i onmen . Fu he mo e, he in e iewees go
o in ensi e ca e uni s o he acquisi ion o knowledge and skills, in
addi ion o he nu se-pa ien a io, which allows o mo e and be e
ca e o people. This is one o he main di e ences ha we could poin
om o he ca e con ex s, jus like gene al wa ds [44].
In e e ence o posi i e ela ionships wi h colleagues and he sense o
eamwo k, hese a e desc ibed as b inging joy o wo k and con ibu ing
o nu se a ac ion. Teamwo k and cohesi e ela ionships in he wo k-
place a e impo an con ibu o s o job sa is ac ion and, consequen ly,
a ac ing new s a [45]. The wo k en i onmen is essen ial and, in he
ICU speci ically, i is ela ed o a high a ac ion and loyal y o heal h-
ca e pe sonnel [46], since he suppo o colleagues is posi i ely asso-
cia ed wi h he wo k commi men o nu ses [47]. To ensu e good
eamwo k, adequa e s a hi ing is also conside ed essen ial. The aban-
donmen o he p o ession has accele a ed he need o imp o e wo king
condi ions, inc easing inde ini e con ac s and dec easing mig a ion
episodes o o he heal h sys ems [48], which is a p oblem we ha e been
s uggling wi h o a long ime in ou con ex .
Social ecogni ion and ca ing o he emo ional heal h o he s a
hemsel es is impo an o he in e iewees. Ve bal and w i en p aise
is highly alued and con ibu es o mo i a ion and sa is ac ion [49].
Lack o ecogni ion has been iden i ied as a signi ican p edic o o
bu nou [50]. The e o e, i is impo an o be awa e ha nu ses may no
be ecei ing posi i e eedback and o p o ide in en ional and genuine
p aise. Job sa is ac ion is co ela ed wi h emo ional heal h and, conse-
quen ly, wi h he appea ance o bu nou , so i s p e en ion is essen ial
[51]. Fu he mo e, acili a ing wo k-li e balance is essen ial, since ICU
nu ses ha e complained on mul iple occasions abou ma a hon wo k
days, isola ed om hei amilies o ensu e hei sa e y, and he
emo ional s ain o dealing wi h ongoing dea h [52]. Galuska e al. [53]
easse ha nu sing supe iso s a e key in hese ma e s, which should
acqui e he ans o ma ional leade ole a e e y ime, suppo ing and
esponding o hei wo ke s wi h oppo uni ies o g ow h and p o es-
sional ul illmen .
S eng hs and limi a ions
The main limi a ion o his pape was ha he in e iews we e ca -
ied ou in only wo au onomous egions o he coun y, and could ha e
co e ed some mo e, inc easing he ans e abili y o he analyzed e-
sul s. Howe e , an a emp was made o ensu e he quali y o he da a by
including in he s udy wo cul u ally di e en egions wi hin he same
na ional con ex , bo h in nu sing aining and in socioeconomic and job
ac o s. To he bes o ou knowledge, his is he i s s udy ha in-
es iga es how o a ac alen o he ICU in a quali a i e design, ins ead
o ocusing on he in en ion- o-lea e o on he engagemen ac o s like
much o he published e idence.
Conclusions
The c ea ion o in ensi e ca e uni s ha a ac nu sing alen is
necessa y o ensu e quali y ca e, gi en he complexi y o he in-
e en ions and he p essing lack o mo i a ed nu ses. ICU nu ses
conside ha a p o essionally appealing ICU is he one ha is commi ed
o quali y con inued aining, de eloping men o ship p og ammes
which a o p o essional au onomy and in ellec ual s imula ion wi h he
applica ion o holis ic ca e, all o his oge he wi h an op imal welcome
o new p o essionals, whe e good eamwo k is p omo ed and s a egies
o main aining emo ional heal h a e de eloped wi h ecogni ion, in-
e en ions o p e en bu nou synd ome and mo i a ion o eaching.
Implica ions o p ac ice and p ospec i e
The e i emen o nu sing p o essionals in all a eas and, especially in
R.-J. Fe n´
andez-Cas illo e al.
In ensi e & C i ical Ca e Nu sing 87 (2025) 103937
5
in ensi e ca e, makes i di icul o main ain op imal ca e co e age.
This, added o he speci ici y o nu sing skills in he ICU and he
complexi y o a ac ing nu ses o in ensi e ca e uni s, becomes an
impedimen when i comes o ensu ing an adequa e and gua an eed
gene a ional eplacemen o pa ien ca e. The esul s o his s udy aim
o know how o a ac nu sing alen o ICUs and wha s a egies o
ollow o con e hese wa ds in o appealing uni s o nu ses. Wi h his,
we will be able o imp o e no only he quali y o ca e o c i ically ill
pa ien s, bu also he sa is ac ion o amilies, manage s and ellow nu ses
wi h high expe ience in he ICU by hi ing alen ed and p o essional
nu ses.
Funding s a emen
This esea ch did no ecei e any speci ic g an om unding
agencies in he public, comme cial, o no - o -p o i sec o s.
CRediT au ho ship con ibu ion s a emen
Ra ael-Jesús Fe n´
andez-Cas illo: W i ing – o iginal d a , Visuali-
za ion, So wa e, P ojec adminis a ion, Me hodology, In es iga ion,
Fo mal analysis, Da a cu a ion, Concep ualiza ion. Luis Basco-P ado:
W i ing – e iew & edi ing, Supe ision, In es iga ion, Fo mal analysis,
Concep ualiza ion. Ma a Rau ell-To ed`
a: W i ing – e iew & edi ing,
Supe ision, Fo mal analysis.
Decla a ion o compe ing in e es
The au ho s decla e ha hey ha e no known compe ing inancial
in e es s o pe sonal ela ionships ha could ha e appea ed o in luence
he wo k epo ed in his pape .
Acknowledgemen s
We would like o show ou mos deep g a i ude o all he pa icipan s
who ga e us hei ime and opinions, which a e he key o his pape . We
eally hope ha all o hei job condi ions do no hing bu imp o e.
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