A surprising number of the nation's neonatal intensive care units (NICUs) have too few nurses, a new study by researchers from the University of Pennsylvania and the University of Medicine and Dentistry of New Jersey (UMDNJ) has found.
Infants in understaffed units were more likely to get infections, which decrease the chance that these fragile babies will survive, the study also found. Infections also increase costs. An added wrinkle is that Medicaid, which pays for the care of 42 percent of preterm and low-birth-weight infants, no longer reimburses hospitals for expenses associated with infections acquired in the facility.
Eileen Lake, an associate professor of nursing and health policy at Penn, said most infections -- staph bacteria are the most common culprit -- stem from the tiny catheters that give these immature bodies fluids, nutrition, and medicine. She suspects that overworked nurses may have less time to devote to catheter hygiene. The babies, she said, "are a uniquely vulnerable group."
The study, published last week in JAMA Pediatrics, looked at staffing in 560 of the nation's 900 NICUs in 2008 and 2009.
The group included a disproportionate number of magnet hospitals for nursing. That designation certifies that those hospitals provide high- quality nursing care, but it does not consider staffing ratios, said Lake, a coauthor. The research team compared staffing levels to those recommended by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Association of Women's Health Obstetric and Neonatal Nurses. These are guidelines, not regulation or law. Lake said some hospitals might have had trouble interpreting the guidelines. Her inter- disciplinary team, she said, has created clearer definitions for what kind of patient needs a particular level of staffing.
The study found that NICUs were understaffed for 32 percent of their patients. Staffing was inadequate for 68 percent of high-acuity infants, or the sickest 8 percent.
Lake said an average NICU in the study had 30 beds. While the standards would have called for 15 nurses per shift, the average was 12.
The infection rate in NICUs that had proper staffing was 9 percent. It was closer to 20 percent for hospitals in the bottom 10 percent for staffing. Those hospitals, Lake said, would have had about nine nurses for 30 babies.
"There is a definite need for NICUs to assess their compliance with guidelines," said Jeannette Rogowski, a health economist at UMDNJ and lead author of the study.
Hospitals, Lake said, now "have an opportunity to evaluate what their staffing is and decide whether they want to staff differently."
Contact Stacey Burling
at 215-854-4944 or [email protected] ___