Nurse Understaffing Increases Infection Risk in Very Low Birth Weight Babies

Thelma Patrick co-author and co-investigator in NICU staffing study

Columbus, OH (March 20, 2013)— In a JAMA-Pediatrics report released this week, Thelma Patrick, PhD, RN, associate professor at The Ohio State University College of Nursing, co-authored a study on nurse staffing levels’ influence on death rates in very low birth weight infants.

I have past experience as a nursing administrator of a women's and children's nursing service, thus I was responsible for decisions regarding staffing of an NICU that was a part of that service.  It is from that experience, and well as my knowledge of the high risk newborn that I make a contribution.  

Thelma PatrickVery low birth weight (VLBW) infants weighing less than 3.25 pounds, account for half of infant deaths in the United States each year, yet a new study released in today’s issue of JAMA-Pediatrics documents that these critically ill infants do not receive optimal nursing care, which can lead to hospital-acquired infections that double their death rate and may result in long-term developmental issues affecting the quality of their lives as adults.

These vulnerable infants are the highest risk pediatric patients in hospitals and account for half of all infant deaths in the country each year. These hospital-acquired infections afflicted 13.9 percent of these frail infants in 2009, the last year reported in the study.

Patrick was involved in the piloting of various data collection tools, developing and presenting study plans and results to the nursing leadership and staff of the participating hospitals, and disseminating progress in or studies to neonatal specialty organizations.  

“In addition to my research contributions, this multidisciplinary team benefited from the combined expertise of two health economists, a neonatologist and leader at a quality collaborative for neonatal care, a nurse/sociologist with expertise in nursing work environments and quality of care,” said Patrick.

The authors studied very low birth weight infants cared for in 67 Neonatal Intensive Care Units (NICU).

“One-third of NICU infants were understaffed, according to current guidelines. Understaffing varies further across acuity levels with the greatest fraction of understaffed infants (92 percent) requiring the most complex critical care, translating into a needed 25% increase in the numbers of nurses,” wrote co-principal investigators Jeannette A. Rogowski, PhD, the University Professor in Health Economics at the UMDNJ-School of Public Health and Eileen T. Lake, PHD, RN, FAAN, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

The researchers noted that infection caused four to seven days of longer hospitalization with associated increased costs, notably to Medicaid. “Under recent changes in Medicaid policy, hospitals will no longer be reimbursed for the costs associated with these infections,” said Lake. “Sadly, because Medicaid is the largest payer for premature newborns, the additional costs may lead hospitals to further cut the nursing staff, leading to a cycle of infection and mortality that could impact even more of these fragile infants.”

 The researchers examined data from 67 NICUs involving 4,046 nurses and 10,394 infants in 2008 and 3,645 nurses and 8,804 infants in 2009-10. The research was funded by the National Institute for Nursing Research and the Robert Wood Johnson Foundation. 

Portions reprinted with permission of the University of Pennsylvania School of Nursing