Nurse understaffing associated with higher rates of NICU infection

[TiffyRN, BSN, PhD]

This is the only language the powers that be will understand is when research establishes actual consequences to shortchanges in care. Especially when their funding starts getting cut.

Nurse Staffing and NICU Infection Rates

http://archpedi.jamanetwork.com/article.aspx?articleid=1669323

[NicuGal, MSN, RN]

We have been tracking this in our unit. And it is true.

[Jory, MSN, APRN, CNM]

The unit that I used to work in has significantly increased the nurse/baby ratio and then then the central line infections, which had been a once-a-year occurrence, starting happening every week.

Do you think they changed anything regarding the staffing?

Oh heck no...they just yelled at the employees that they were not doing their job.

There is a difference between not doing your job out of negligence and not doing your job because you have too much to do.

I feel sorry for any baby that gets admitted to that unit.

[twinkletoes53]

I posted a link to that article on my Facebook page, with a comment about how we as nurses have known this for years. I am no longer working, but the NICU I was in recently lost a significant number of staff nurses. Nurse to patient ratio increased. If you were caring for an infant on ECMO, or head cooling, or on an oscillator with multiple drips, for example, it used to always be a 1:1 assignment. Not any more.

Another example: We used to have an RN whose main job was to audit & monitor PICCs, Broviac catheters, and other CVLs. We were an 85 bed Level IV NICU, with a high percentage of infants with these lines in. Size of the NICU is now @ 100 beds. Of course all staff were trained in care of these lines-- how to change IVF, do dressing changes on Broviac catheters,etc. Our CVL nurse would check and change PICC line dressings during the day. We had a dedicated group of 2-3 staff/shift who would do dressing changes on PICC lines if they became loose @ night. They also repaired these lines if needed, under MD orders.

As staff numbers decreased, our CVL nurse was told that she would now have to take on a patient load, in addition to monitoring all the PICCs and CVLs in the NICU. Secondary infection rates due to CVLs and PICCS went from negligible to approximately 10-15 per year soon after this was done. She came in on her days off, on different shifts, to reinforce protocol for our lines.

She has recently resigned from the hospital after close to 25 years of employment, mostly due to her frustrations at changes in standards of care in our NICU.

She is not the only one frustrated. After the hospital announced cuts in pay, hours, and benefits, it lost over 200 nurses. The NICU lost 40 experienced staff in the first 6 months after changes were made, in early 2011. According to Administration, these cuts were necessary due to upcoming changes in the way the hospital was being reimbursed for Medicaid. The hospital had been operating in the red. Last year it made a $50 million profit.

But @ what cost?

[Jory, MSN, APRN, CNM]

A huge cost because no doubt there were some deaths associated with those infections.

[NicuGal, MSN, RN]

And soon we won't be reimbursed by insurance companies for central line infections.