Nurse understaffing in NICUs is widespread, particularly in high-acuity infant care
THURSDAY, March 21 (HealthDay News) -- Understaffing of neonatal intensive care units (NICUs) is common and is associated with an increased risk of nosocomial infection in very low-birth-weight (VLBW) infants, according to a study published online March 18 in JAMA Pediatrics.
Jeannette A. Rogowski, Ph.D., from the University of Medicine and Dentistry of New Jersey in Piscataway, and colleagues conducted a retrospective study to examine the adequacy of NICU nurse staffing in the United States and its association with infant outcomes using data from all VLBW infants with a NICU stay of at least three days, discharged from the 67 NICUs in the Vermont Oxford Network in 2008 (5,771 infants) and 2009 (5,630 infants). Nurse understaffing was assessed relative to acuity-based guidelines using survey data from 2008 and for four complete shifts in 2009 to 2010.
The researchers found that, compared with guidelines, hospitals understaffed 32 percent of their NICU infants and 92 percent of high-acuity infants. On average, an additional 0.11 of a nurse per infant overall and 0.39 of a nurse per high-acuity infant would be required to meet minimum staffing guidelines. Infection rates for VLBW infants were 16.5 percent in 2008 and 13.9 percent in 2009. An understaffing level that was one standard deviation higher correlated with significantly increased likelihood of infection (adjusted odds ratios, 1.39 for 2008 and 1.39 for 2009).
"In conclusion, our findings suggest that the most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care," write the authors.
One author disclosed financial ties to ArborMetrix.
Abstract (http://archpedi.jamanetwork.com/article.aspx?articleid=1669323#Abstract )Full Text (subscription or payment may be required) (http://archpedi.jamanetwork.com/article.aspx?articleid=1669323 )