Nurse Staffing in Neonatal Intensive Care Units in the United States.
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009-2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting.
Rutgers, The State University of New Jersey, New Brunswick, NJ.
Jeannette A
JA
Rogowski
Dartmouth College, Hanover, NH.
Douglas O
DO
Staiger
The Ohio State University, Columbus, OH.
Thelma E
TE
Patrick
University of Vermont, Burlington, VT.
Jeffrey D
JD
Horbar
University of Vermont, Burlington, VT.
Michael J
MJ
Kenny
Jessie M. Scott Endowed Term Associate Professor of Nursing and Health Policy, Associate Professor of Sociology, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104.
Eileen T
ET
Lake
D002983:Clinical Competence; D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D017283:Neonatal Nursing / Q000458:organization & administration*; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D062072:Patient Acuity; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*
NICU; hospitals; neonatal intensive care; nurse-patient ratio; nursing care; patient acuity; staffing and scheduling