The NICU: Safety in Numbers

The Link Between RN Staffing and Infection in the NICU

Laura A. Stokowski, RN, MS


June 26, 2013

In This Article

Walking a Fine Nurse Staffing Line

It can't be easy to staff a hospital in the current economic climate and still maintain the financial bottom line. A fluctuating census and sporadic nursing shortages make staffing some units challenging. Accepted guidelines for "minimum staffing levels" may or may not match the characteristics of a particular hospital or unit, such as patient population, diagnostic mix, or the experience level of its nursing staff. With declining reimbursements, hospitals might perceive that they simply can't afford to staff to recommended levels and keep their doors open. Administrators must walk a fine line between too few and just enough nurses for safe and effective care.

The trend toward value-based hospital reimbursement makes it more important than ever to avoid costly adverse events such as death, readmission, infection, pressure ulcers, postoperative complications, and medication errors. These events have been linked in many studies to insufficient nurse staffing levels, also known as nurse:patient ratios. Nurse leaders are under pressure to increase efficiency yet maintain quality of care and avoid adverse patient outcomes.

To date, most studies of the impact of insufficient nurse staffing levels have been conducted in adult inpatient settings. A recent study was the first of its size to explore nurse:patient ratios in the neonatal intensive care unit (NICU), a nursing care-intensive setting where the risks for, and consequences of, errors are unusually high. This Robert Wood Johnson Foundation and National Institute of Nursing Research-sponsored study was conducted by researchers at 5 different academic institutions (University of Pennsylvania, University of Medicine and Dentistry of New Jersey, Ohio State University, Dartmouth College, and the University of Vermont) in collaboration with the Vermont-Oxford Network (VON) and published in JAMA Pediatrics.[1]


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