THE 19TH AUSTRALIAN & NEW ZEALAND SCIENTIFIC I MEETING ON INTENSIVE CARE CONFERENCE ASTRACTS I Eight months of painstaking assessment resulted in the design of a combination of 9.5 hour (dayhight) and 4.75 hour (evening) shifts. The initial roster design was developed by ICU staff, but its implementation outside ICU was supported by 83% of nurses. There are sixteen EFT combinations, comprising full shifts (9.5hrs)and half shifts (4.75hrs), The roster creates a 23.75 hour day 6 days a week replacing the current 25.5 hour day. The 28.5 hour seventh day is the professional staff development day. The 9.5 hour shifts incorporated in this roster system allows staff to work 38 hours in 4 days, This maintains the additional rostered day off per month without the costs of ADO replacement. Whilst the primary purpose of the roster was to deliver sav- ings, additional benefits included increased staff development time, review of work practices, improved continuity of care, and improved staff morale since the introduction of 'JenaRos' an automatic rostering software. The roster is expected to achieve savings of $750,000, 5% of nursing salaries expenditure in the first twelve months of operation, with the ICU saving $80,000, This is achieved by reducing the shift overlap, or handover, from 27.5 hours per day to 1 hour per day. As a result of significant savings numerous entitlements were negotiated in our Enterprise Agreement, including 12% of savings to a nurses trust fund. Symposia 22nd October, 1994 First line nursing care of the critically ill in Rural areas Anne Lea. CNC Critical/Emergency Care, Central West Critical Care Networks, NSW Primary obstacles to the delivery of emergency care in rural areas are the distance and the associated time taken to re- suscitative and definitive care. This is further compounded by the centralisation of resources (including personnel) at the base hospitals. Critically ill/injured persons are often transported to small district hospitals, bypass being inappropriate due to distance and time factors. In these centres doctors are not on-site and at times are not available. Nurses therefore play a key role in emergency management. However, they are frequently working in isolation with limited education and support, their infrequent exposure to critically ill or injured persons renders the acquisition and retention of emergency care knowledge and skills difficult. The following strategies have been implemented to address these issues. Clinical nurse consultants in emergency/critical care, have been appointed to each of the former health regions. Emergency care courses for registered and enrolled nurses are conducted and advanced life support skills are reassessedannually. 'On-site' education at district hospitals is provided regularly and staff exchange programs are encouraged. Perhaps the most positive outcome of the aforementioned strategies has been the networking that has evolved, allowing the sharing of ideas, knowledge and resources and serving as a support mechanism. Evaluation of these and other programs, case review and anecdotal information, indicate that problems associated with the delivery of emergency care in rural NSW, can be overcome. A cohesive and coordinated systems approach can be augmented through education and networking. Free Papers 22nd October, 1994. A qualitative study of the spouse's experience following coronary artery bypass surgery: Implications for Nursing Practice Jennifer M Cow, Karen A Theobald and Christina M Nagle School of Nursing, Queensland University of Technology and The Wesley Hospital, Brisbane, Queensland. Findings from numerous quantitative studies suggest that spouses of patients undergoing Coronary Artery Bypass (CAB) surgery experience both physical and emotional stress before and after their partner's surgery. Such studies have contributed to our understanding of the spouses' experiences, however they have largely failed to capture the qualitative experience of what it is like to be a spouse of a partner who has undergone CAB surgery The objective of this study was to describe the experience of spouses of patients who had recently undergone CAB surgery. This study was guided by Husserl's phenomenological approach to qualitative research. In accordance with the nature of phe- nomenological research the number of participants necessarily needs to be small because phenomenology values the unique experience of individuals.Therefore this study gathered data from four participants utilising open ended indepth interviews. The method of analysis was adapted from Amedeo Giorgi's five step empirical phenomenological process which brackets preconceived notions, reducing participants' accounts to the essential essence or meanings. Numerous themes common to each of the spouses emerged. These included: seeking information; the necessity for rapid decision making; playing guardian; a desire to debrief with their partner and lastly, uncertainty of their future role. This study has attempted to understand the phenomena of the spouse's experience and in doing so, believe that we now have a better understanding and insight into the needs of spouses of CAB surgery patients. This has added another dimension to our existing body of knowledge and further facilitates holistic patient care. Free Paper 22nd October, 1994 Clinical decision making by critical care nurses: behaviours and attitudes Tracey K. Bucknall La Vobe Universitx Melbourne. Critical care nurses make multiple decisions rapidly in a highly complex environment in order to deliver expert individualised care. Although nurses are accountable and responsible for their decisions, there is minimal knowledge about the types of deci- sions made and the problems experienced by critical care nurses. A survey of practicing Victorian critical care nurses, who were members of the CACCN (Vic Branch), was conducted to deter- mine the frequency with which particular decision tasks occur and the relationships between the nurses characteristics and the decision activities. This survey sampled nurses from a cross section of critical care units which varied in size, type and location. Most signifi- cantly, there was substantial variation in type and frequency of decision making which occurred both within activities and across activities. Frequencies that depended on the nurses training and