Sunday, Sep 26 - Expo Hall Opening
Sunday, Sep 26 - Job Fair
Monday,
Sep 27 - AWHONN's Block Party
Monday, September 27, 2010
: 2:00 PM
Title: The Three Es: How Neonatal Staff Nurses' Education, Experience and Environments Impact Infant Outcomes
Venetian
Audio File
Discipline: Professional Issues (PI)
Learning Objectives:
Submission Description:- Interpret acuity-adjusted staffing ratios for use in NICU staffing
- Describe the relationship between professional practice environments and NICU complications
- Describe the relationship between nurse staffing levels and mortality
Research Objective: Neonatal nurses care for one of the highest-risk patient populations: VLBW infants. These infants, treated in NICUs, are closely monitored and provided with an array of life support measures and intensive interventions. The large variation in outcomes across NICUs that currently exists cannot be explained by differences in patient or NICU characteristics, such as volume or NICU level. Since NICU cases are among the most nurse-intensive hospitalizations, nursing care may explain some of this variation and provide an opportunity for improving outcomes for these infants. In this first large-scale U.S. study of nursing effects on NICU outcomes, we examine whether variation in acuity-adjusted nurse staffing and environments contribute to the variation in NICU patient outcomes.
Study Design: In this observational study, we collected data in March 2008 on patient acuity and the practice environment via web survey of 6400 nurses working in 104 NICUs from the Vermont Oxford Network (VON), an international quality improvement collaborative. Independent variables were the ratio of observed to expected nurse-to-infant ratio for each unit, compositional features of the nursing staff (education, certification, experience), and the hospital’s ANCC certified magnet status. Practice environment was measured with the Practice Environment Scale of the Nursing Workforce Index, a nationally-endorsed nursing care performance measure. Infant outcomes were measured from the VON database for calendar year 2007 (N=8490). Outcomes were analyzed in random-effects logit models which correct for clustering within hospitals of patients. Patient characteristics, including gestational age, 1-minute APGAR score, race, gender, and prenatal care were included as control variables.
Population Studied: Very low birthweight infants in neonatal intensive care units
Principal Findings: The average nurse cared for two infants, but this varied considerably by infant acuity. For the highest and lowest acuity infants, the average nurse-to-infant ratio was 0.95 and 0.34, respectively. The overall proportions of staff with bachelor’s degrees, ≥5 years of nursing experience, and neonatal specialty certification, were 56%, 74% and 19% respectively. Hospitals with better educated, more NICU-experienced nurses, staffed at lower levels. The sample of hospitals was exceptional in the large fraction (33%) with certified nursing magnet status, compared to hospitals nationally (6%). There was significant variation across units in infant outcomes. Average rates were mortality, 11%, nosocomial infection, 17%, and severe intraventricular hemorrhage (SIVH), 7%. Nurse staffing, proportion of BSNs, and magnet status were significantly associated with mortality. Infants in the most professional practice environments had lower odds of infection, and infants in units with more experienced NICU nurses had lower odds of SIVH.
Conclusions: Nurse staffing and environments explain some of the variation in neonatal outcomes across NICUs. Hospitals appear to be doing some smart trading-off: Bachelor’s-prepared nurses and more NICU-experienced nurses are more efficiently able to care for VLBW infants.
Implications for Policy, Delivery or Practice: We were able to measure and describe acuity-adjusted staffing, which is a powerful tool for neonatal nurse managers to use in planning staffing needs. Additionally, our findings suggest the importance of professional practice environments, staffing, and nurse characteristics in ensuring optimal neonatal outcomes.
Study Design: In this observational study, we collected data in March 2008 on patient acuity and the practice environment via web survey of 6400 nurses working in 104 NICUs from the Vermont Oxford Network (VON), an international quality improvement collaborative. Independent variables were the ratio of observed to expected nurse-to-infant ratio for each unit, compositional features of the nursing staff (education, certification, experience), and the hospital’s ANCC certified magnet status. Practice environment was measured with the Practice Environment Scale of the Nursing Workforce Index, a nationally-endorsed nursing care performance measure. Infant outcomes were measured from the VON database for calendar year 2007 (N=8490). Outcomes were analyzed in random-effects logit models which correct for clustering within hospitals of patients. Patient characteristics, including gestational age, 1-minute APGAR score, race, gender, and prenatal care were included as control variables.
Population Studied: Very low birthweight infants in neonatal intensive care units
Principal Findings: The average nurse cared for two infants, but this varied considerably by infant acuity. For the highest and lowest acuity infants, the average nurse-to-infant ratio was 0.95 and 0.34, respectively. The overall proportions of staff with bachelor’s degrees, ≥5 years of nursing experience, and neonatal specialty certification, were 56%, 74% and 19% respectively. Hospitals with better educated, more NICU-experienced nurses, staffed at lower levels. The sample of hospitals was exceptional in the large fraction (33%) with certified nursing magnet status, compared to hospitals nationally (6%). There was significant variation across units in infant outcomes. Average rates were mortality, 11%, nosocomial infection, 17%, and severe intraventricular hemorrhage (SIVH), 7%. Nurse staffing, proportion of BSNs, and magnet status were significantly associated with mortality. Infants in the most professional practice environments had lower odds of infection, and infants in units with more experienced NICU nurses had lower odds of SIVH.
Conclusions: Nurse staffing and environments explain some of the variation in neonatal outcomes across NICUs. Hospitals appear to be doing some smart trading-off: Bachelor’s-prepared nurses and more NICU-experienced nurses are more efficiently able to care for VLBW infants.
Implications for Policy, Delivery or Practice: We were able to measure and describe acuity-adjusted staffing, which is a powerful tool for neonatal nurse managers to use in planning staffing needs. Additionally, our findings suggest the importance of professional practice environments, staffing, and nurse characteristics in ensuring optimal neonatal outcomes.
