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VOL: 98, ISSUE: 40, PAGE NO: 31 Lee Goodare is assistant clinical editor, Nursing Times Critical care is not confined to patients in high dependency units. Those on the wards can suddenly

become critically ill and patients in need of critical care may be placed on acute wards because of shortages of intensive care beds. This puts ward nurses in a difficult position in terms

of critical care skills because a patient may be deteriorating after surgery and critical care interventions may be needed urgently. Critical care is not confined to patients in high

dependency units. Those on the wards can suddenly become critically ill and patients in need of critical care may be placed on acute wards because of shortages of intensive care beds. This

puts ward nurses in a difficult position in terms of critical care skills because a patient may be deteriorating after surgery and critical care interventions may be needed urgently. With

luck, a nurse will be there to notice the deterioration and, if appropriately trained, will give the patient the input required. Serious problems arise when these needs are not met. And even

when they are met, it is essential to have enough staff to care for the non-critical patients who are on the ward. Philip Woodrow (p32) looks forward and discusses an initiative by East

Kent Hospitals NHS Trust to provide training for ward nurses delivering critical care. When I worked on acute wards I would often have: 10 other patients to care for; oral, enteral,

nasogastric and intravenous drugs to administer; meals to give out; four patients waiting for non-existent beds; and bags of IV fluids to keep to time. There would also be mouth care for

palliative patients, caring for wounds and central lines, and the mentoring of a student. Many nurses will realise that this list is not hyperbolic. A patient who becomes critically ill on a

ward requires the full attention of trained staff. Comprehensive Critical Care (DoH, 2001) states that a patient's needs are determined by the level of care that his or her condition

requires, not by the designation of the bed in which the person happens to lie. But this is not the case as such situations still happen, compromising the well-being of all patients on the

ward and wearing down even the most experienced nurses. The feedback from the staff who have attended the course run by Mr Woodrow has been positive. As always, nurses are eager to refine

and expand their existing skills and such initiatives can empower them and boost their morale. But nurses also require a workplace with the infrastructure to support their knowledge and

enable it to be used. The provision of a safe ratio of staff to patients is the only way that this can happen. Until then, luck will continue to play a significant and disturbing part in

critical care interventions at ward level.