A Model of Nursing Care Microsystems for a Large Neonatal Intensive Care Unit

Karen A. Goldschmidt, RNC, MSN; Peggy Gordin, RNC, MS, CNAA, FAAN


Adv Neonatal Care. 2006;6(2):81-88. 

In This Article

Abstract and Introduction

Nationally the number and size of neonatal intensive care units (NICUs) continues to grow. Today, NICUs with >40 beds, often referred to as "megaunits," are not uncommon. Staff in large units find it challenging to maintain teamwork, communication, and continuity of nursing care for patients. Families find large units overwhelming. In large NICUs, nurse leaders struggle to achieve a balance between parent satisfaction with care provided and nursing job satisfaction.

This article describes the development of a new model of nursing practice, a nursing team microsystem. This innovative model has the unique effect of creating smaller units within the larger one, using highly skilled nursing teams, that are geographically grouped to provide care for infants and their families. The model supports teamwork, communication, continuity of care, and has shown a positive impact on both family and nurses' job satisfaction.

An increase in premature births, coupled with the demand for highly specialized newborn care, has increased the need for neonatal services, creating a proliferation in the number and size of neonatal intensive care units (NICUs) across the nation.[1,2,3,4,5] Children's hospitals are busier than ever; admission to NICUs accounts for >20% of their inpatient volume.[3] As NICUs continue to grow, questions emerge: "How big is too big?" "What is the impact of large units on the patient and family?" and "With the large number of staff needed, how will continuity and quality of care be maintained?"

Although advances in neonatal care have improved outcomes for high-risk infants, in 2002 infant mortality rates increased in the United States, the first increase in over 40 years.[2,6,7] This increase is attributed to advances in reproductive technology and increases in the number of births of preterm, low-birthweight infants.[1,2,3,6,7,8,9] Newborn intensive care units play a vital role in reducing infant mortality; however, considerable variability in outcomes exists among individual hospitals and physicians.[1,5,6,9,10,11,12,13]

Differences in NICU outcomes may be related to how systems of care are organized.[12,13,14] There is a lack of research that examines NICU characteristics and care practices that affect quality of care.[1,10,15] Gaps in knowledge remain regarding the impact of patient care models on the patient, care provider, and organizational outcomes.[16,17]

Healthcare quality research indicates that a focus on developing excellent practices within clinical microsystems, defined as small clinical units serving specific patient populations, can improve patient outcomes.[14] This article will describe the creation of nursing care microsystems in a 50-bed Level III NICU. This patient-care model improves continuity of care, enhances communication, and promotes nurses' job satisfaction.


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