title: Critical Care Nursing's Impact on Pediatric Patient Outcomes.
abstract: BACKGROUND
  Previous studies have demonstrated the effect of adult nursing skill mix, staffing ratios, and level of education on patient deaths, complication rates, and failure to rescue (FTR). To date, only one known study had examined the effect of nursing experience and education on postoperative pediatric cardiac operations.
  
  
  METHODS
  Nursing survey data were linked to The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database for patients undergoing cardiac operations (2010 to 2011). Logistic regression models were used to estimate associations of nursing education and years of clinical experience with in-hospital mortality rates, complication rates, and FTR. Generalized estimating equations and robust standard error estimates were used to account for within-center correlation of outcomes.
  
  
  RESULTS
  Among 15,463 patients (29 hospitals), the in-hospital mortality rate was 2.8%, postoperative complications occurred in 42.4%, and the FTR rate was 6.4%. After covariate adjustment, pediatric critical care units with a higher proportion of nurses with a Bachelor of Science degree or higher had lower odds of complication (odds ratio for 10% increase, 0.85; 95% confidence interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of nurses with more than 2 years of experience had lower mortality rates (odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99; p = 0.025).
  
  
  CONCLUSIONS
  This is the first study to demonstrate that higher levels of nursing education and experience are significantly associated with fewer complications after pediatric cardiac operations and aligns with our previous findings on their association with reduced deaths. These results provide data for pediatric hospital leaders and reinforce the importance of organization-wide mentoring strategies for new nurses and retention strategies for experienced nurses.
authors.affiliation: Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, Massachusetts. Electronic address: patricia.hickey@childrens.harvard.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hickey
authors.affiliation: Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Connor
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.affiliation: Johns Hopkins Children's Heart Surgery, All Children's Hospital, St. Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D064648:Critical Care Nursing / Q000379:methods*; D006330:Heart Defects, Congenital / Q000451:nursing / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016017:Odds Ratio; D011182:Postoperative Care / Q000451:nursing*; D011183:Postoperative Complications / Q000453:epidemiology / Q000451:nursing*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology