Factors Impacting Safety in Nursing in Adult Intensive Care Units: An Integrative Review of the Literature

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Purpose: The purpose of this paper is to review recent literature on safety in nursing and adult intensive care units to identify interconnected themes.

Background: Gaps in literature related to recent challenges encountered in intensive care units (ICUs) during the COVID-19 pandemic and a focused interest in the promotion of positive outcomes led us to explore what factors impact safety in nursing in adult ICUs.

Methods: A literature search for articles published between 2015-2021 was conducted using PsycINFO, OVID, Academic Search Complete, and CINAHL. Keywords searched were “intensive care unit”, “ICU”, “Critical Care”, and “Safety in nursing.” After a review of the articles, 19 were selected to include in the present review.

Results: A total of six themes were identified throughout the literature: Competence, Equipment, Workload, Communication, Unit Specifics, and Nurse Perception.

Conclusion: Given the multiplicity of factors affecting safety in the ICU, it is clear that more targeted research is needed to assure practice guidelines are evidence based. Not only do the safety themes examined in this review reflect areas of interest for patient safety, but also for safety around systems, staffing, and outcomes.

Keywords: safety in nursing, ICU, critical care


Ashley Stevenson graduated Magna Cum Laude with her Bachelor of Science in Nursing from East Carolina University in 2011 with Foundational Curriculum Honors. As a Registered Nurse she has a demonstrated work history with 9 years of experience in the Medical ICU. She is currently the Clinical Supervisor of a Cardiac Sheath Post-Procedural Unit and is board certified in Cardiac-Vascular Nursing. In May of 2021 she is expected to graduate Summa Cum Laude with her Master of Science in Nursing with a concentration in Nursing Administration from the University of North Carolina at Charlotte. She was honored to be inducted into Phi Kappa Phi National Honor Society and Sigma Theta Tau International Honor Society of Nursing. She is passionate about leadership and plans to continue her education and professional growth as a nurse leader.

Lisa Dovoedo received her Bachelor of Science in Nursing from the University of North Alabama.  She worked as a registered nurse in cardiac telemetry as a new graduate nurse and after relocating to Charlotte, North Carolina, she now specializes in emergency nursing. She has worked as an emergency department nurse in several hospitals in the Charlotte region. Currently, Lisa is a graduate student at the University of North Carolina at Charlotte, studying adult-gerontology acute care nurse practitioner.

Jenifer Simone, RN, BSN, NCSN has 26 years of experience in pediatric nursing and is currently working toward a Master of Science degree in Nursing Systems and Populations at The University of North Carolina at Charlotte.  She worked as a school nurse for over 10 years and is currently a regional school health nurse consultant for the NC Department of Health and Human Services.  She is passionate about school health and is committed to improving the health and well-being of youth in her community through both professional and volunteer activities.

Emily Volk is a Registered Nurse working in Quality Management at Northern Regional Hospital in Mount Airy, North Carolina. A 1999 graduate of Brigham Young University, Emily holds a Bachelor’s degree in nursing, and is completing coursework for a Masters in Nursing Administration at the University of North Carolina, Charlotte.

Emily serves as a member of the Interdisciplinary Stroke team and leads the Accountable Care Organization and Care Coordination efforts for Northern. Emily is also integral to the Patient Satisfaction efforts at Northern and is a champion of promoting and sustaining the culture of Compassion that exists in the organization.