Authors

  1. Potera, Carol

Abstract

Children fare better with more RNs on staff.

 

Article Content

Studies have shown clearly that adequate RN staffing improves the care of hospitalized adults (see In the News, April and August). Now a study examining RN staffing and outcomes in children shows the benefits to young patients, too. In the first large-scale study of its kind, researchers at the University of North Carolina School of Nursing found fewer complications in hospitalized children when RNs provided more hours of care and where nurse staffing levels were high.

 

They examined data on 3.65 million patients up to age 14 discharged from California hospitals between 1996 and 2001. Adverse events included septicemia, death, postoperative cardiac and pulmonary complications, pneumonia, and urinary tract infection. The researchers used a risk-reduction model to calculate how adding one hour of RN care per patient per day would affect the rates of these adverse outcomes.

  
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Their analysis showed that the largest reductions in complications would be seen at hospitals with the lowest levels of RN staffing. In the estimate, rates of cardiopulmonary complications declined by 4.4%; pneumonia, by 2.3%; and postoperative septicemia and other infections (except urinary tract infection), by 3.8%. Hospitals with the highest staffing levels benefited from additional RN care as well, but the reductions in complications were smaller. For instance, postoperative cardiopulmonary problems fell by 3.1%; pneumonia cases, by 1.7%; and cases of septicemia and other infections, by 3.4%. Moreover, the results suggest that postoperative cardiopulmonary complications could have been avoided in an estimated 425 to 596 children, pneumonia in 95 to 124 children, and septicemia in 719 to 787 others, had enough RNs been in place during the study period. The estimated rates of death and postoperative urinary tract infections were not decreased by increases in RN staffing.

 

"We still don't know what the 'correct' staffing ratios are," notes lead researcher Barbara Mark. She also points out that although California mandates minimum staffing ratios, their impact on care quality still must be evaluated. For states or hospitals considering such guidelines, says Mark, "it's important to have the broad participation of nurses in formulating them."

 

Carol Potera

 

NewsCAP

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Mark BA, et al. Policy Polit Nurs Pract 2007;8(2):83-92.