**2.4 Staffing impact, coronavirus disease 2019 (COVID-19) era and current challenges**

The COVID 19 pandemic spurred on a mass workforce exodus from healthcare and increasing emotional distress, impacting all levels of care across the healthcare continuum, including the critical care environment [70]. Considering this new phenomenon, organizations were forced to reimagine innovative ICU care models [71], recognizing that the ICU of the future will have a different team composition

with varied operational strategies [72]. The ongoing challenge healthcare institutions encounter is the increasing number of patients with life-threatening conditions in critical care settings. A decreased supply of critical care staff created from a "deficit status quo" [73] and the additional COVID-19 pandemic burden have exacerbated the current systems, putting patient safety at risk. Evidence demonstrates that nursing staffing and workload in the ICU have a direct impact on mortality rates, nosocomial infections, increased length of hospital stay (LOS) and overall inferior nursing performance [74]. The COVID 19 pandemic prompted older generations to retire, mothers decided to stay at home and care for their children due to a lack of available childcare, while others decided to leave healthcare altogether and pursue other careers. There is increasing evidence that nurses plan to leave the workforce at a faster rate when compared with the past decade [75]. As a result, the Great Resignation shifted the predominant workforce characteristics towards younger and less experienced staff compared to the pre-pandemic workforce. Research suggests that novice nurses are more prone to make medical errors, impacting the quality of care provided to their patients and driving the healthcare community to search for innovative approaches in education and clinical practice [76]. Younger generations prefer collaboration over competition and mentorship relationships with their bosses over the standard hierarchical structures in healthcare organizations [77]. This preference can be harnessed to drive patient safety initiatives in critical care while helping co-create new collaboration models.

This technology-savvy workforce also demands more sophisticated hardware and software that enables their professional responsibilities. Modernizing, enhancing, and automating processes and integrating systems that improve the ICU workflows will be crucial to retaining the current workforce.

Understanding the needs of the current workforce will help organizations develop retention strategies, create an enjoyable work environment, and subsequently improve patient safety. Intangibles such as job structures that can maintain a better work-life balance, burnout prevention, and joy creation will be non-negotiable.
