Knowledge, practices, and perceived barriers to nurse-driven hypotension management among intensive care unit nurses: A cross-sectional study

OBJECTIVES: Hypotension is a common and clinically significant issue in the intensive care unit (ICU), associated with increased morbidity and mortality. ICU nurses play a central role in its detection and initial management, yet their ability to act autonomously might be limited. Insights into their knowledge and perspectives regarding nurse-driven hypotension treatment are currently lacking. The aim of this study was to assess ICU nurses' knowledge and current practices in hypotension management and to identify perceived barriers to the implementation of nurse-driven hypotension management protocols. METHODS: A single-centre, cross-sectional survey was conducted among ICU nurses at the Amsterdam University Medical Center between February and May 2021. A convenience sampling approach was used, inviting all eligible nurses attending a scheduled annual education day to participate. The questionnaire assessed knowledge, clinical practices, and attitudes towards nurse-driven hypotension management. Descriptive statistics were used for quantitative data; open-ended responses were analysed qualitatively using content analysis by two independent researchers. RESULTS: The response rate was 99% (140/142). Nurses reported encountering hypotension in 55.1% of ICU shifts. Over 80% supported nurse-led treatment, and 68.6% reported already initiating treatment independently in 70% of hypotensive events. Knowledge assessments showed high item-level correctness (>80%) in treatment-related questions. However, lower scores were observed in the interpretation of more complex haemodynamic cases, with correct response rates ranging between 36.4% and 48.1%. The most important perceived barrier to implement a nurse-driven protocol was potential uncertainty about patient inclusion and exclusion criteria. CONCLUSION: ICU nurses frequently manage hypotension independently and support nurse-driven protocols. Knowledge gaps, particularly in complex haemodynamic reasoning, highlight the need for structured education and clear, evidence-based protocols to ensure safe and effective nurse-driven interventions in high-acuity ICU settings.