Developing Organizational Policies and Practices







The ICU nurses experience psychological stress which affects their general nursing performance. However, there are competing needs that impact psychological stress among ICU nurses. First, the continuous presence of family members in the ICU limits the efficiency of nurses during the provision of care to ICU patients. As a result, nurses are compelled to care for both patients and family members. The “perceived interference” by the family members emanates from differences in educational, cultural and religious backgrounds. Consequently, the family members require support from the nurses which is not outlined in the ICU nurse’s job description. This requires the nurse to work extra hours to attend to both the patient and the family members. This strain experienced by the nurses induces psychological stress and eventually burnouts which lead to poor nursing services in the ICU. Secondly, there is a limited number of trained ICU nurses in the organization. This creates a need for long working hours by the available ICU nurse. On average, an ICU nurse is likely to stay in the shift for approximately seventeen hours. However, Kumar et al (2016) argues that long working hours by ICU nurses leads to increased burnouts and high levels of patient dissatisfaction. Also, long working hours are associated with poor psychological health like anxiety and depression.

The organization has implemented a working schedule policy to assist the ICU nurses in planning. The policy describes two shifts; the day and night shifts. The weekend schedule starts from Friday to Saturday which is an eight-hour-long schedule. Based on this policy, any changes to the shift should be done after one month. However, this only happens when the head nurse receives a notification addressing illness and emergency leave from a nurse. This indicates that the schedule continues for even three months if no emergencies and illnesses present. On the other hand, ICU nurses are allowed two days off per week although this rarely happens due to the limited number of trained ICU nurses in the organization. Any absenteeism by the ICU nurse would lead to an increase in the workload of other nurses. Nevertheless, the day shifts start at 6.001m and end at 6.00pm. This is similar to the night shift which starts at 6.00pm and ends at 6.00am. Consequently, the organizational policy dictates that each shift is 12 hours long. In case of emergency, illness, and absenteeism the shifts are more than 12 hours long.

The 12-hour working policy has faced criticisms from critiques who believe that 12-working hours create a potential risk to the patients. According to Webster et al (2016), long working hours lead to increased errors among the ICU nurses which result from increased fatigue. Fatigue among ICU nurses emanates from inadequate rest, straight shifts and sleep loss. This organizational policy regarding the working hours results to reduced motivation, increased accidents, slow reaction time, decreased productivity and omission of details which compromises patient safety. Nevertheless, this policy ensures that a nurse is attending to the ICU patients at all times. Also, the 12-hour shift policy has assisted the organization in curbing the effects resulting from the organizational shortage of trained ICU nurses. The nursing code of ethics stipulates that a nurse should cause no harm to the patient. Unfortunately, the 12-hour work schedule is less flexible as compared to an 8-hour work schedule for nurses (Tahghighi et al, 2017). The increased risks for patient safety violate this ethical code. The main ethical challenge experienced by the ICU nurses is on providing efficient services to ICU patients while maintaining high levels of alertness when working a 12-hour shift.

To balance the competing needs, the organization must adopt policies that promote an 8-hour work schedule for ICU nurses. First, the organization must involve the nurse in the future and present schedule. Through this, the opinions of nurses are considered when creating the working schedule. This motivates the nurse’s thus increasing job satisfaction. Also, the organization needs to adopt an 8-hour work policy. The 8-hour shift creates more time for ICU nurses to relax and engage in activities that promote mental health (Webster et al, 2018). This will increase wakefulness among ICU nurses thus reducing experiences of burnouts among the nurses. Also, this 8-hour work policy promotes ethical practice in nursing. This is because reduced errors promote the quality of care of the ICU patients which leads to increased patient satisfaction. Also, the organization needs to create a clear policy for managing the family visits of ICU patients (Zboril-Benson, 2016). Such a policy will address the visiting hours and support for the family members. This will not only create room for nurses to care for ICU patients but also identify the need for health professionals to handle the family members of the ICU patients.


Kumar, A., Pore, P., Gupta, S., & Wani, A. O. (2016). Level of stress and its determinants among Intensive Care Unit staff. Indian journal of occupational and environmental medicine20(3), 129.

Tahghighi, M., Rees, C. S., Brown, J. A., Breen, L. J., & Hegney, D. (2017). What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review. Journal of advanced nursing73(9), 2065-2083.

Webster, J., McLeod, K., O’Sullivan, J., & Bird, L. (2018). Eight-hour versus 12-h shifts in an ICU: Comparison of nursing responses and patient outcomes. Australian Critical Care.

Zboril-Benson, L. R. (2016). Why nurses are calling in sick: the impact of health-care restructuring. Canadian Journal of Nursing Research Archive33(4).

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