How to Solve Your ICU Staffing Challenges

May 8, 2025

With a labor shortage continuing to place stress on understaffed intensive care units, hospital leaders are being forced to grapple with how to provide high-quality critical care with a limited supply of experienced clinicians.

One solution is, unfortunately, not an option for the vast majority of hospitals: throwing money and people at the problem. Budgets have been stretched thinner than ever as margins erode, and there simply aren’t enough intensivists, critical care nurses and nurse practitioners available to provide the staffing ratios necessary for achieving optimum patient coverage.

Let’s look more closely at the current staffing situation, including where hospitals need to be for both nursing and intensivist coverage, and analyze solutions that can enable appropriate levels of care without sacrificing budget.

Understanding Current Best Practices

To understand what is currently considered to be an adequate staffing level, especially as viewed through Leapfrog and other ratings criteria, it helps to examine resources put forth by clinicians and hospital safety purveyors.

Last year, the American Association of Critical-Care Nurses (AACN) released their proposed threshold for offering requisite staff coverage within an ICU . AACN Standards for Appropriate Staffing in Adult Critical Care offer a litany of recommendations for hospital leaders to consider. Among them:

• Clinical leaders such as charge nurses, educators and nurse managers are not included in patient assignments, except in rare crisis situations.
• Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.
• Organizational staffing plans anticipate that critically ill or injured patients generally require a ratio of one nurse to two patients (emphasis my own).

Achieving this ideal state (which requires adherence to four additional standards as well) is growing increasingly out of reach in many healthcare markets.

And that’s just on the nursing side; the problem of inadequate ICU staffing also persists and deepens on the physician side, although there has been some progress made in this regard. In the Society of Critical Care Medicine’s Critical Care Workforce Update from 2023, the authors cite data from the American Association of Medical Colleges that shows 14,159 critical care physicians across the nation in 2022, which was actually higher than the 13,093 such physicians in 2020.

However, this increase in the available pool of physicians is somewhat countered by an attendant increase in burnout. That same paper notes that up to 71% of intensivists are experiencing some level of burnout, the highest among all physician classifications. That means the intensive care field is at increased risk of losing talented physicians if that high-stress environment persists year after year.

The availability of intensivists can’t be underestimated, as it’s one of the key factors weighed by Leapfrog when evaluating hospitals’ ICUs. As they note in their Fact Sheet about ICU Physician Staffing (IPS):

“A growing body of scientific evidence suggests that quality of care in hospital ICUs is strongly influenced by: (i) whether “intensivists” are providing care; and (ii) how the staff is organized in the ICU.”

By “how the staff is organized in the ICU,” Leapfrog is referring to the practice of offering open or closed ICUs, i.e. whether or not physicians pull double duty between other areas of the hospital and the ICU (open) or the physicians exclusively treat patients within the ICU (closed). As Leapfrog notes (in their 2020 fact sheet but, interestingly, not their 2023 fact sheet), closed ICUs with physicians who can focus all their time and attention on patients who need the highest acuity care see lower mortality rates than ICUs where intensivists have to share their time with other areas of the hospital.

To meet the Leapfrog IPS standard, an ICU must be managed or co-managed by intensivists, and they must be practicing exclusively within the ICU and be available during daytime hours. If they can’t be on site, then they must be available to respond to an alert within 5 minutes, or be able to direct a qualified clinician to respond within that same time frame.

How to Meet Critical Care Staffing Guidelines

Based on the nursing and intensivist criteria above, is your hospital equipped to meet Leapfrog’s IPS standard and provide an adequate level of nursing support to maintain high-quality patient care?

You can check your Leapfrog grade at this link. If the answer is no, then I’d love to say you just need to hire more intensivists and nurses to cover your ICU. But as we emphasized at the beginning of this article, that obvious answer ignores an unfortunate reality: there isn’t enough hospital budget and experience to go around to ensure adequate staffing is even achievable.

When forced to confront this reality, you’re likely wondering what a possible path forward could be. Thankfully, Leapfrog’s Fact Sheet on IPS staffing also hints at one possible solution: tele-critical care.

If your hospital is faced with a situation where it’s simply not realistic to have an intensivist on site and focused exclusively on ICU patients, tele-critical care can be used to supplement the capabilities of the on-site team. In these situations, a highly skilled tele-intensivist can manage high-acuity patients to ensure they’re receiving the appropriate attention. They can do this during daytime hours, in a situation where an on-site intensivist isn’t available or has to split their time with other departments, or they can do this during nighttime hours, when a hospital doesn’t have the intensivist coverage necessary to properly oversee all ICU patients.

Virtual nursing can also help address many of the issues that prevent hospitals from meeting the standards of the American Association of Critical-Care Nurses. Having an available virtual nurse to assist patients can ensure that nursing leaders don’t wind up having patients assigned to them in instances of low staffing. Virtual nursing can also assist with patient ratios for frontline ICU nursing staff, ensuring that when a perfect 2:1 ratio can’t be achieved, some of that workload can be put on the experienced virtual nurse off-site.

Throwing more people at the problem isn’t an option for hospitals that seek to provide the best care possible to patients and achieve the highest quality scores. It’s therefore imperative that ICU leaders consider creative ways to supplement the on-site teams they do have, through tele-critical care, virtual nursing and other digital solutions that connect ICUs with experienced physicians and other medical team leaders.

To learn more about supplementing your on-site team with Intercept Telehealth, reach out today. Find out how ICU staffing challenges are increasingly being managed in modern hospitals.