Lead author Dr. Jochen Profit, an assistant professor of pediatrics—neonatology and of medicine—health services research at BCM, said increased patient-to-nurse ratios have been associated with negative outcomes in many kinds of patients in intensive care units and in hospital settings, but there have been no definitive studies in the newborn intensive care setting.
Making the grade
The information is needed to guide health policy decisions on how best to deliver care, Profit said. There are existing regulations prescribing patient-to-nurse ratios for infants in the intensive care and intermediate-care nursery. Nursing groups are advocating more such legislative mandates on nursing staffing.
In this study, small intensive care units averaged 2.1 babies per nurse and the larger ones, 2.7 to one.
“Hospitals receive benchmarks (or grades) for quality of care, which are used as a profiling tool for health insurance companies,” he said.
The team found that the number of babies per nurse is not a valid marker of quality for grading the care given to infants born five to 10 weeks early and treated in newborn intensive care units.
No relevant associations
To come to this observation, Profit and colleagues analyzed data from a study of 850 infants from 10 neonatal intensive care units in California and Massachusetts. The team looked for associations between patient-to-nurse ratios and a variety of clinical outcomes including infections, bleeding in the brain, eye disease, breastfeeding at discharge, emergency visits, and hospitalization after discharge.
The group found no clinically relevant associations between an increase in the patient-to-nurse ratio and these outcomes.
There was a slight decrease in daily weight gain when there were more babies per nurse, but Profit said, “Clinically, this may not be relevant.”
There is a significant difference in research in adults and premature babies, Profit said, and while this study found little influence on commonly measured clinical outcomes, it is possible that better nurse staffing may benefit more severely premature infants. Bottom line, this study suggests that the number of patients per nursing staff should not be used to determine whether a newborn intensive care unit delivers good quality of care to moderate premature infants.