Changes to nurse-to-patient ratios in intensive care during the pandemic

The ‘gold standard’ ratio in adult intensive care units (ICUs) has been in place for more than 50 years, and was initially established in 1967 (Royal College of Nursing (RCN), (2020a). This continued to be the recognised standard for decades until 2020.

In 2000, the Department of Health (DH) published a review of adult critical care services in England, which classified patients according to their clinical need from level 0 to 4 (DH, 2000; Dutton and Finch, 2018). This review led to the concept of critical care ‘without walls’—it identified the presence of acutely unwell patients outside the ICU and acknowledged that specialist nurse education and training was now required in all areas of clinical practice in recognition and preliminary management of acute deterioration (Dutton and Finch, 2018).