title: Neonatal nurse staffing and delivery of clinical care in the SSBC Newborn Network.
abstract: OBJECTIVE
  To measure nursing workload and timely completion of essential tasks in relation to the staffing levels recommended by the British Association of Perinatal Medicine (BAPM) in Staffordshire, Shropshire and Black Country Newborn Network.
  
  
  METHODS
  A prospective observational study was conducted measuring the time taken by selected nurses to undertake the necessary tasks for babies receiving different levels of care in the Network's six constituent neonatal units. An independent observer was used. The unit and individual's workload was evaluated against BAPM standards. Delays in essential predetermined tasks were recorded. The impact on quantity of care given and on the number of delayed tasks were compared between those with the recommended workload or less and those overstretched.
  
  
  RESULTS
  Between October 2008 and February 2009, 89 nurses were observed caring for 244 neonates over 534 h. 54% of nursing shifts failed to meet BAPM standards. Nurses with workload greater than the BAPM-recommended levels demonstrated a 28% decrease in median time spent on clinical care per baby. 92 (17%) essential tasks were delayed >1 h or not done. Delays/omissions were more likely when BAPM standards were not met (53% vs 40%, p=0.049). In nursing observations without delays/omissions, accommodating for adequate nursing breaks and working in the same area, nurses could cater for no more than 1.2, 1.5 and 2.7 babies in intensive care, high dependency care and special care, respectively.
  
  
  CONCLUSIONS
  Understaffing leads to measurable problems including delays to essential treatment and reduced clinical care. BAPM standards are not aspirational and should be regarded as a minimum. Further research on optimising nursing care efficiency with limited nursing resources is necessary.
authors.affiliation: Department of Paediatrics, New Cross Hospital, Royal Wolverhampton Hospitals Trust, UK. tilly.pillay@nhs.net
authors.forename: Thillagavathie
authors.initials: T
authors.lastname: Pillay
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Sarah
authors.initials: S
authors.lastname: Owen
authors.forename: Denise
authors.initials: D
authors.lastname: Kirby
authors.forename: Andy
authors.initials: A
authors.lastname: Spencer
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D017283:Neonatal Nursing / Q000458:organization & administration*; D015401:Nursing Administration Research / Q000379:methods; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011446:Prospective Studies; D011787:Quality of Health Care; D013997:Time Factors; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data