title: Strategies to address management challenges in larger intensive care units.
abstract: OBJECTIVE
  To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU).
  
  
  BACKGROUND
  The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise.
  
  
  METHODS
  Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa.
  
  
  RESULTS
  Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses.
  
  
  CONCLUSIONS
  ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified.
  
  
  CONCLUSIONS
  This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs.
authors.affiliation: Department of Health Studies, University of South Africa, Pretoria, South Africa.
authors.forename: M C
authors.initials: MC
authors.lastname: Matlakala
authors.affiliation: Department of Health Studies, University of South Africa, Pretoria, South Africa.
authors.forename: M C
authors.initials: MC
authors.lastname: Bezuidenhout
authors.affiliation: Department of Health Studies, University of South Africa, Pretoria, South Africa.
authors.forename: A D H
authors.initials: AD
authors.lastname: Botha
mesh_terms: D001291:Attitude of Health Personnel; D064648:Critical Care Nursing / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D009745:Nursing, Supervisory / Q000458:organization & administration*; D010557:Personnel Administration, Hospital; D010865:Pilot Projects; D015397:Program Evaluation; D036301:Qualitative Research; D011787:Quality of Health Care; D013019:South Africa
keywords: ICU management challenges; ICU manager; large intensive care unit (ICU); strategy