title: The effect of critical care nursing and organizational characteristics on pediatric cardiac surgery mortality in the United States.
abstract: OBJECTIVE
  This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States.
  
  
  BACKGROUND
  Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality.
  
  
  METHODS
  Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years.
  
  
  RESULTS
  The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality.
  
  
  CONCLUSIONS
  These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hickey
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Martha A Q
authors.initials: MA
authors.lastname: Curley
authors.forename: Jean A
authors.initials: JA
authors.lastname: Connor
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D064648:Critical Care Nursing / Q000458:organization & administration*; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D015279:Organizational Culture; D010371:Pediatric Nursing / Q000458:organization & administration*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology