From its inception as a speciality area of clinical practice, intensive care has undergone constant advancement. This advancement shapes the practise of nursing in the intensive care unit (ICU). It also results in the emergence of ever-changing and new patient groups. As these new patient groups emerge, nurses are faced with the challenge of caring for vulnerable patients whose needs may be different, however, the model of care has yet to change to accommodate that difference. It is important to recognise how practice change related to advancement in the care of critically ill patients, such as the introduction of new medications, techniques, or technology, can have unintended and unforeseen consequences that may only be recognised years after their introduction. For every advance, there are consequences, and their multidimensional impacts can only be appreciated when healthcare professionals consider how their models of care need to constantly change to meet the needs of all patient groups, and their families.

A consequence of advances in life-sustaining therapies in the ICU is the emergence of a group of patients that survive their initial critical illness, only to then become dependent on life-saving interventions for a prolonged time, necessitating a protracted stay (Kahn et al., 2015). The international literature demonstrates that 5–10% of ICU patients have a prolonged stay, using 25–30% of ICU bed days (Ambrosino & Vitacca, 2018; Iwashyna et al., 2016) and resulting in a difficult clinical trajectory for patients, their family and healthcare professionals who provide their care (Minton, 2017). A protracted ICU stay is not a new phenomenon, but the patient group affected by this phenomenon has developed and changed since the inception of intensive care as a speciality. By viewing this ever changing group of patients retrospectively we can identify the challenges this group has on nurses’ practice, which is the first step to improve care.