Overcoming the obstacles to caring for the long-term critical care patient.

Caring for the critically ill long-term patient is a challenge. Although such patients must remain in the critical care environment because of the nursing expertise they require, they are often viewed as low-priority patients by the staff because of two factors. One factor relates to the nurse. Critical care nurses, typically action-oriented, function best during crisis intervention and are rewarded for technical skills and efficiency. The other factor relates to the patient. The critically ill long-term patient's needs are different from those of patients most often seen in critical care units; therefore, required nursing interventions are different. These interventions may not be within the nurse's usual repertoire of knowledge and skills and may also be physically and psychologically draining. Implementation of appropriate strategies has the potential for reducing length of stay, cost to the patient and the hospital, and stress for the critical care staff.