Better Nurse Staffing Requires a Strong Business Case

(Health Leaders Media) From examining nurse staffing issues to bringing nurses’ depression out of the dark, the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) is helping to improve nursing.

A review of research studies funded by INQRI found a significant increase in the amount and quality of research evidence that links nursing and quality of care since 2005. Also, INQRI has increased and improved the set of research measures that can be used to identify and quantify nurses’ contributions to improving acute patient care, the review showed.

Moreover, the most vulnerable babies are also the ones that are most understaffed. And troublingly, the study found that nurse understaffing was associated with higher rates of infections among NICU babies.

Take one of the latest of these studies, out this month, which shows that nurse understaffing is rampant in NICUs. The study, published in the journal JAMA-Pediatrics, found that very few neonatal intensive care units (NICUs) provide sufficient numbers of nurses to meet the American Academy of Pediatrics’ staffing guidelines.

The researchers examined nurse staffing levels in 2008 and 2009 for NICU infants in 67 hospitals that are part of the Vermont Oxford Network (VON). The team also examined the rate of hospital-acquired infections in blood or cerebrospinal fluid among very low birth weight (VLBW) infants in the NICU at the study hospitals during the same time period. These infections can come from central venous lines, which administer medication or fluids and are maintained by nurses.

The American Academy of Pediatrics’ staffing guidelines recommend a nurse-to-patient ratio of one nurse for every three to four infants for the lowest risk babies and a ratio of more than one nurse per baby for the most complex cases.

On average, however, hospitals understaffed about one third of all NICU infants. More than half the hospitals understaffed one in four babies, with the highest risk infants more frequently understaffed (9 out of every 10 babies).

VON is a voluntary hospital network that aims to improve the quality and safety of care for newborns and their families, but according to the researchers, their NICUs were still woefully understaffed.

“Hospitals in this study had better overall nurse staffing than most hospitals with a NICU in the U.S., and yet, the understaffing levels are striking, suggesting that most hospitals are falling even further short of the accepted guidelines for staffing critically ill infants,” Eileen T. Lake, PhD, RN, FAAN, nursing professor and associate director of the Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania, said in a statement.

Yet hospitals that wish to beef up the nurse staffing in their NICUs may have trouble doing so. The INQRI research review reveals that it’s difficult to establish a business case for investing in nursing “because those investments tend to improve patient outcomes,” researchers said.

Improving patient outcomes leads to reduced readmissions, and therefore, also reduces the need for additional care, researchers said. The key, according to the review, is research that examines reductions in healthcare costs and that’s replicable, since it could help support a business case for nursing.

So the bottom line for NICUs that want to increase their staffing is the bottom line: Make the business case for it.