Nursing Shortage Linked to NICU Infection Rates

A new study claims that neonatal intensive care units (NICUs) are widely understaffed, potentially contributing to the increased risk of infection in critically ill newborns.

Researchers at the University of Medicine and Dentistry of New Jersey (Piscataway, USA) conducted a retrospective cohort study involving 67 NICUs from the Vermont Oxford Network, reviewing data on 5,771 very low birth weight babies (VLBW) with a NICU stay of at least 3 days from 2008 and 5,630 VLBW from 2009. Nurse understaffing was assessed based on survey data in 3008 (4,046 nurses and 10,394 infant assignments) and 2009 (3,645 nurses and 8,804 infant assignments).

The results showed that infection rates for VLBW infants were 16.5% in 2008 and 13.9% in 2009, and that NICU nurse understaffing was directly associated with increases in infection risk among very low birth weight infants. For example, a 1-standard deviation increase in nurse understaffing per infant was associated with an adjusted odds ratio (AOR) of 1.39 higher risk of infection in both 2008 and 2009.

Relative to the guidelines, hospitals understaffed 32% of their NICU infants in 2009 and 48% in 2008, with understaffing varying by acuity. Hospitals understaffed 85% of high-acuity infants in 2008 and 92% in 2009; in all hospitals understaffed nearly one-third of their NICU infants and more than 90% of their high-acuity NICU infants, relative to staffing guidelines. In order to meet minimum staffing guidelines, hospitals would need, on average, an additional 0.11 nurses per infant overall and 0.39 nurses per high-acuity infant at 2009 levels. The study was published early online on March 18, 2013, in JAMA Pediatrics.

“The most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care,” concluded Jeannette Rogowski, PhD, and colleagues. “Staffing levels in all US NICUs may be lower than those observed here. Sample NICUs may have better trained nurses than other hospitals, and this training composition may influence nurse staffing. However, the guidelines indicate that a specialized staff is the minimum expectation.”

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University of Medicine and Dentistry of New Jersey