2. Workforce

Standard 2.1

• The ICU director (or delegate) is responsible for ensuring medical staff working in the ICU have competency according to local needs.
• ICUs should provide immediate 24 hours a day, 7 days a week (24/7) on-site access to a doctor with advanced airway and vascular access skills. The local health district (LHD) intensive care committee should define the minimum skill set.¹ This skill set should include:
  • bag mask ventilation
  • use of adjunct airway devices
  • laryngeal mask insertion
  • endotracheal intubation
  • emergency surgical airway
  • intravascular catheter placement (large bore)
  • central venous access device insertion (peripherally inserted central catheter and central venous line)
  • arterial line insertion
  • intercostal catheter insertion
  • intra osseous line insertion.
• If the designated medical officer does not have the above skills, the ICU should have immediate access to another medical officer with these skills. Services may need a documented formal agreement with relevant medical departments to ensure coverage.
• When caring for paediatric patients, clinicians should refer to Managing a High Acuity Child Outside of a Tertiary Children’s Hospital: Key Principles for additional skill and support requirements.²

Standard 2.2

• Services should base the number and skill level of nurses on the number and acuity of the patients within each unit and department.
• Local workforce planning should also consider additional services provided by the ICU which may include, but not be limited to, rapid response teams and outreach patient management, the physical layout of the hospital and frequency of outside services.³

Standard 2.3

• Services may roster the nurse in charge after hours when the nursing manager is not on duty; or additional to the nursing manager, dependant on the service.
• The role of the nurse in charge is to coordinate patient services and maintain unit management and nursing staffing on an allocated shift.

Standard 2.4

• Promote nursing workforce to complete the NSW Health Education and Training Institute (HETI) intensive care transition to speciality practice program.⁴
• Support nurses to complete postgraduate qualifications in critical care where appropriate.
• Specialist-trained intensive care nurses play a critical role in supporting the delivery of safe, high-quality care to patients and their families. ⁵
• The nursing workforce needs an appropriate skill balance to support ongoing management of critically ill patients in the units.^{1, 5-8}

Standard 2.5

• The CNE delivers and evaluates clinical education programs at the unit level and performs the following functions:^{1, 9}
  • Delivers competent nursing education in the ward or unit
  • Contributes to the development of colleagues
  • Supports less experienced staff and acts as preceptor for new staff
  • Acts as the preceptor in orientations to the ward or unit
  • Provides day-to-day clinical education support in the ward or unit
  • Provides one-on-one informal education
  • Provides support for skill development in clinical procedures
  • Provides support for professional development
  • Provides support for clinical policy development
  • Provides a ward or unit-based in-service program
• The role of any CNC may vary by unit but should include clinical service and consultancy, clinical leadership, research, education and clinical services planning and management.¹⁰
• The service should decide whether additional clinical support roles (such as ACCESS nurses) are necessary based on the unit activity, acuity and services provided within and outside of the unit and determined locally.

Standard 2.6

Consider access to staff who can:

• support the holistic needs of ICU patients
• provide safe, culturally sensitive and personalised care to priority populations, including Aboriginal people, people from culturally and linguistically diverse backgrounds, people with a disability, LGBTIQ+ individuals, and refugees and asylum seekers.^11-15

Aboriginal workforce in NSW Health

• Aboriginal Liaison Officers (ALOs), Aboriginal Health Practitioners (AHPs) and Aboriginal Health Workers (AHWs) all play vital roles in providing culturally safe and supportive healthcare to Aboriginal patients and their families.^{16, 17}
• Together, ALOs, AHPs, and AHWs enhance the delivery of culturally safe care in ICU settings by:^{16, 17}
  • supporting Aboriginal patients and families with culturally appropriate care and emotional support
  • facilitating effective communication between patients, families, and healthcare providers
  • assisting with care coordination, discharge planning, and advocating for culturally specific needs
  • improving patient engagement and experience through culturally informed support within ICU services.

Standard 2.7

• Allied health professionals are a critical part of the multidisciplinary team and should be included in all relevant clinical discussions and care planning.
• Consider ICU acuity and skill mix when planning allied health staffing. More advanced or specialised staffing skill mix is appropriate for higher patient acuity and complexity.
• Allied health professionals play important roles in ICU with regards to patient care and family welfare.
• After-hours access to allied health professionals may be required for certain clinical situations.
• Consider the use of virtual care to support access to allied health professionals.
• The allied health professions listed below (but not limited to), support the multidisciplinary intensive care team and care planning on a regular basis:
  • Pharmacist
  • Physiotherapist
  • Dietitian
  • Social worker
  • Speech pathologist
  • Occupational therapist
  • Radiographer

Standard 2.8

• Sufficient non-clinical staff should be available to carry out non-clinical support duties, supporting clinical staff caring for ICU patients.^{1, 8, 18}
• This may include (but not be limited to) some of the following roles and functions:^{1, 8, 18}
  • Data manager
  • Biomedical engineering
  • Administration officers
  • Stores and equipment support
  • Ward assistant, ward person, security
  • Cleaners
  • Pastoral care

References

1. The Faculty of Intensive Care Medicine. Guidelines for the provision of intensive care services. 2026 [cited 20 Jul 2026].
2. NSW Agency for Clinical Innovation. Managing a high acuity child outside of a tertiary children's hospital: Key principles. Syd: ACI; 2024 [updated 1 May 2024; cited 1 Feb 2025].
3. NSW Ministry of Health. Guide to the Role Delineation of Clinical Services (2026). Syd: NSW Health. 2026 [cited 2 Jul 2026].
4. Health Education and Training Institute (HETI). Intensive Care Transition to Specialty Practice. 2023–2026.
5. Critical Care Service Ontario. Adult critical care - Levels of Care. 2020 [cited 1 Feb 2025].
6. Endacott R, Pattison N, Dall'Ora C, et al. The organisation of nurse staffing in intensive care units: A qualitative study. J Nurs Manag. 2022;30(5):1283-94. DOI: 10.1111/jonm.13611
7. The Canadian Association of Critical Care Nurses. Models of nursing care in the critical care unit. Canada: CACCN; 2019 [cited 1 Feb 2025].
8. Australian College of Critical Care Nurses. Workforce Standards for Intensive Care Nursing Melbourne: ACCCN; 2016 [cited 1 Feb 2025].
9. Accreditation Agrement Canada Qmentum. Standards - Critical Care Services. 2019 [cited 1 Feb 2025].
10. NSW Ministry of Health. List of Domains and Functions for Clinical Nurses and Midwives. Syd, NSW Health; 2024 [cited 1 Feb 2025].
11. NSW Health. Meeting the needs of priority populations. Syd: NSW Health; 2024 [cited 1 Feb 2025].
12. NSW Government. Communicating Positively: A Guide to Appropriate Aboriginal Terminology. Syd: Centre for Aboriginal Health; 2019 [cited 1 Feb 2025].
13. NSW Ministry of Health. Aboriginal Cultural Training – Respecting the Difference. Syd: NSW Health; 2022 [cited 1 Feb 2025].
14. NSW Ministry of Health. Responding to the health care needs of people with disability. Syd: NSW Health; 2024 [cited 1 Feb 2025].
15. NSW Ministry of Health. NSW Plan for Healthy Culturally and Linguistically Diverse Communities: 2019-2023. Syd: NSW Health; 2019 [cited 1 Feb 2025].
16. NSW Ministry of Health. Aboriginal Health Worker workforce. Syd: NSW Health; 2025 [cited 1 Feb 2025].
17. NSW Ministry of Health. NSW Aboriginal Health Plan 2024-2034. Syd: Centre for Aboriginal Health; 2024 [cited 1 Feb 2025].
18. College of Intensive Care Medicine of Australia and New Zealand. Minimum Standards for Intensive Care Units. 2016 [cited 1 Feb 2025].