title: The relationship of nurse staffing, skill mix, and Magnet recognition to institutional volume and mortality for congenital heart surgery.
abstract: OBJECTIVE
  The aim of this study was to examine the relationship of nurse staffing, skill mix, and Magnet(R) recognition to institutional volume and mortality for congenital heart surgery at children's hospitals.
  
  
  BACKGROUND
  Little is known about how nurse staffing, skill mix, and Magnet recognition influence outcomes in children's hospitals.
  
  
  METHODS
  Cases of congenital heart surgery were identified from the 2005-2006 Pediatric Health Information System Database using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The National Association of Children's Hospitals and Related Institution database was used for staffing data and verified by chief nursing officers; Magnet recognition was obtained from the American Nurses Credentialing Center Web site. Relationships among nursing characteristics, volume, and mortality were examined.
  
  
  RESULTS
  Among children undergoing congenital heart surgery at major children's hospitals, there was marked variation in intensive care unit (ICU) nursing hours per patient day (14.96-32.31). Variation in ICU nursing skill mix was less extreme (80%-100%); 20 hospitals had 100% registered nurse staffing in ICUs. There was a significant difference in median nursing skill mix between Magnet and non-Magnet hospitals (P = .02). None of the nursing characteristics was associated with mortality. However, higher nursing worked hours was significantly associated with higher volume (rs = 0.39, P = .027). Hospital volume was significantly associated with risk-adjusted mortality.
  
  
  CONCLUSIONS
  Nursing characteristics varied in ICUs in children's hospitals treating congenital heart surgery but were not associated with mortality. There was a significant relationship between ICU nursing worked hours and institutional volume. Nursing skill mix was lower in Magnet hospitals.
authors.affiliation: Cardiovascular and Critical Care Services, Department of Nursing, Children's Hospital Boston, Boston, Massachusetts 02115, USA. Patricia.Hickey@childrens.harvard.edu
authors.forename: Patricia
authors.initials: P
authors.lastname: Hickey
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Jean
authors.initials: J
authors.lastname: Connor
authors.forename: Eileen
authors.initials: E
authors.lastname: Sporing
authors.forename: Kathy
authors.initials: K
authors.lastname: Jenkins
mesh_terms: D002983:Clinical Competence; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009738:Nursing Service, Hospital / Q000458:organization & administration; D009740:Nursing Staff / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*