Pediatric Critical Care Staffing Standards Published

ALISO VIEJO, Calif. – April 29, 2026 – The American Association of Critical-Care Nurses (AACN) has published “AACN Standards for Appropriate Staffing in Pediatric Critical Care,” the newest addition to its evidence-based, specialty-specific staffing resources.

Staffing in pediatric critical care is a unique challenge, because age, developmental considerations and patient- and family-centered care can impact nursing workload. Patients can range from young adults in pediatric intensive care units (PICUs) to the smallest premature neonates in the neonatal ICU. Staffing assignments may also be affected by patient and family characteristics, including the presence or absence of family at the bedside, the need for developmentally appropriate care, such as play and extended time for care-related tasks, and support for new parents, new diagnoses of lifelong illness and social issues.

The staffing standards build upon AACN’s decades of advocacy and collaborative work and provide guidance to improve some of the many processes that affect appropriate staffing for acute and critical care patients. Appropriate staffing is one of the “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards), published in 2005 and updated in 2016 based on new evidence.

The Joint Commission’s recent addition of appropriate staffing as a National Performance Goal for hospitals reinforces staffing as a core component to help ensure quality of care.

Besides the HWE standards, the pediatric critical care staffing standards build on similar standards that AACN developed for adult critical care and for progressive care, while recognizing the commonalities and responding to the differences between the adult and pediatric specialties. The new standards are also informed by AACN’s other influential resources related to nurse staffing, including AACN Synergy Model for Patient Care and its 2018 “Guiding Principles for Appropriate Staffing.”

In addition, the standards respond to recommendations from the Partners for Nurse Staffing Think Tank and the Nurse Staffing Task Force, national work that AACN co-led with other professional organizations. Both groups called for specialty nursing organizations to define staffing standards for the patient populations they serve.

“The number of children with chronic health conditions and complex medical needs is rising, and staffing in pediatric critical care presents complex challenges, without easy answers or fast solutions,” said Rebekah Marsh, president of AACN Board of Directors. “These standards provide a framework broad enough to apply to a wide range of pediatric critical care settings, while also offering specific actions that support nurses and, therefore, the delivery of expert patient care.”

Developed with input from pediatric and neonatal critical care nurses who responded to a survey and/or participated in focus groups, “AACN Standards for Appropriate Staffing in Pediatric Critical Care” outlines seven standards to incorporate appropriate staffing into everyday operations and patient care. Each standard includes actions for organizational leaders, clinical leaders and direct care nurses, as well as exemplars, tools and resources.

The seven standards are as follows:

• Direct care nurses participate in all aspects of staffing: planning, implementation and evaluation.
• Hospital patient care areas establish, evaluate and refine unit-specific staffing guidelines based upon their impact on patient and nurse outcomes.
• For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient’s and family’s needs and align nurse competencies with patient and family characteristics.
• Clinical leaders such as charge nurses, educators, clinical nurse specialists and nurse managers do not take a patient assignment, 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 are designed to prioritize the health of the work environment and thus drive nurse retention and optimal patient outcomes.
• Organizational staffing plans anticipate that critically ill or injured pediatric patients generally require a ratio of at least one nurse for every one to two patients.

The document also includes a section with answers to common questions that arose during the development of the standards, a glossary and references.

“AACN Standards for Appropriate Staffing in Pediatric Critical Care” can be downloaded at no charge on the AACN website after signing in. A print version of the 38-page document can be purchased from AACN’s online store.

The document joins other AACN publications developed to describe the level of practice or performance expected by the nursing profession in order to provide excellent and compassionate care. In addition to the HWE standards and staffing standards, AACN has published guidelines specific to clinical nurse specialists, acute care nurse practitioners, tele-critical care nurses, progressive care nurses and critical care nurses.

About the American Association of Critical-Care Nurses: For more than 55 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 134,000 members and over 170 chapters in the United States.

American Association of Critical-Care Nurses
27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org