[Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles].

Background: In the Federal Republic of Germany, it has been possible for some years to study (intensive) nursing care alongside further training in intensive care and anaesthesia. This results in a nursing skill-grade mix in the intensive care unit (ICU), which nursing management must consider.

Objectives: The aim is to show the development and implementation of a new nursing management structure in the ICU and also provide an overview of the parallel role development with preliminary results at a university hospital.

Materials and methods: Within a working group of nursing management, a narrative analysis of the current situation was carried out with close involvement of the ICU ward managers and the staff units for nursing development, further education and nursing education. The content was organized into subject areas and a new management model was subsequently developed. The evaluation took place narratively within the context of employee interviews.

Results: The management model in the ICU was divided into the areas of nursing management, nursing education, and nursing science as a management triangle. Nursing management is staffed by at least two people as ward managers and deputies, while the nursing education and science team leaders have equal decision-making powers in terms of shared governance. The respective specialist departments work together within the hospital in networks with other ICUs. Other specialist roles such as primary nurses, advanced practice nurses, heart failure nurses or practical instructors are given specific contact persons in the management team to match their tasks, which was viewed positively.

Conclusions: The development of nursing practice can be promoted through close co-operation within the management team.