Dr. Thelma Patrick takes part in interdisciplinary team study published in Journal of American Medical Association

Hospital recognition for nursing excellence plays a role in improving outcomes for very low birth weight infants


Babies born weighing less than 1500 grams (just under three pounds, five ounces) are among the highest risk pediatric patients in hospitals. They account for only 1.5 percent of births but over half of infant deaths. One in four dies in the first year of life and 87 percent of those deaths occur within the first month. Now a new interdisciplinary study reveals that these delicate infants fare better in hospitals that have earned Recognition for Nursing Excellence (RNE) and are designated Magnet Hospitals by the American Nurses Credentialing Center (ANCC).

While they are in the hospital, very low birth weight (VLBW) infants require an intense level of nursing care and nurses caring for these babies must make complex assessments, implement highly intensive therapies and make adjustments in care based on the patient’s response. The study, published in the current issue of the Journal of the American Medical Association and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research suggests that the focus on nursing excellence in Magnet Hospitals improves the care VLBW infants receive and their outcomes.

Eileen T. Lake, PhD, RN, FAAN, associate director of the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania and Jeannette A. Rogowski, PhD, professor in the Department of Health Systems and Policy in the School of Public Health at the University of Medicine and Dentistry of New Jersey led the research team, which also included Thelma Patrick, PhD, RN, associate professor at the College of Nursing, Ohio State University.

The team studied the outcomes of 72,235 VLBW infants weighing between 501 and 1500 grams (roughly one pound, .65 ounces and 3 pounds, five ounces) born in hospitals and placed in neonatal intensive care units (NICUs) between January 1, 2007 and December 31, 2008. They measured the infants’ rates for seven-day, 28-day and hospital stay mortality; severe intraventricular hemorrhage; and nonsocomial (blood or cerebrospinal fluid) infection.

Despite having more risk factors than VLBW infants in the non-RNE hospitals, babies in the RNE hospitals had lower rates of death, hemorrhage and infection. Researchers also recorded the racial and ethnic composition of the infant sample and noted that the proportion of non-Hispanic black infants born in RNE hospitals was significantly lower than the proportion of non-Hispanic black infants in non-RNE hospitals.

“Nurses working with these high-risk babies, usually in the NICU, must constantly be on their toes to monitor their patients for subtle changes or signs of distress that could signal cardiac, respiratory or neurologic problems,” said Lake. “They also have to maintain a scrupulously hygienic environment, especially where catheters are concerned. Hospitals that receive RNE designation are evaluated for many of the attributes associated with nursing excellence, including exemplary professional practice, and implementing new knowledge, innovations and improvements.”

ANCC’s Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Organizations are evaluated for evidence that they have achieved five key elements: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations and improvements; and empirical outcomes. It generally takes two years for a health care organization to achieve Magnet status and hospitals must undergo a redesignation process every four years and provide interim reports.  Only seven percent of U.S. hospitals are Magnet hospitals.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit www.inqri.org or follow on Twitter at @INQRIProgram.

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The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For 40 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.