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Am J Perinatol 2022; 39(06): 640-645
DOI: 10.1055/s-0040-1718571
Original Article

Comparison of Three Nursing Workload Assessment Tools in the Neonatal Intensive Care Unit and Their Association with Outcomes of Very Preterm Infants

Charlotte Lemieux-Bourque
1   CHU de Québec Research Center, Quebec, Canada
2   Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
,
Bruno Piedboeuf
1   CHU de Québec Research Center, Quebec, Canada
2   Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
,
Simon Gignac
3   Neonatal Intensive Care Unit, Montreal Children's Hospital, Montreal, Quebec, Canada
,
Sharon Taylor-Ducharme
3   Neonatal Intensive Care Unit, Montreal Children's Hospital, Montreal, Quebec, Canada
,
Anne-Sophie Julien
4   Statistical Consulting Service, Department of Mathematics and Statistics, Université Laval, Quebec, Canada
,
Marc Beltempo
5   Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
6   McGill University Health Centre Research Institute, Montreal, Quebec, Canada
› Author Affiliations Funding M.B. holds an early career investigator grant from the CIHR Institute of Human Development, Child and Youth Health and the Montreal Children's Hospital Foundation. The funding agencies had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
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Abstract

Objective Nursing workload assessment tools are widely used to determine nurse staffing requirements in the neonatal intensive care unit (NICU). We aimed to compare three existing workload assessment tools and assess their association with mortality or morbidity among very preterm infants.

Study Design Single-center retrospective cohort study of infants born <33 weeks and admitted to a 52-bed tertiary NICU in 2017 to 2018. Required nurse staffing was estimated for each shift using the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) used as reference tool, the Quebec Provincial NICU Nursing Ratio (QPNNR), and the Canadian NICU Resource Utilization (CNRU). Poisson regression models with robust error variance estimators were used to assess the association between nursing provision ratios (actual number of nurses/required number of nurses) during the first 7 days of admission and neonatal outcomes.

Results Median number of nurses required per shift using the WANNNT was 25.0 (interquartile range [IQR]: 23.1–26.7). Correlation between WANNNT and QPNNR was high (r = 0.92, p < 0.0001), but the QPNNR underestimated the number of nurses per shift by 4.8 (IQR: 4.1–5.4). Correlation between WANNNT and CNRU was moderate (r = 0.45, p < 0.0001). The NICU nursing provision ratios during the first 7 days of admission calculated using the WANNNT (adjusted risk ratio [aRR]: 0.96, 95% confidence interval [CI]: 0.93–0.99) and QPNNR (aRR: 0.97, 95% CI: 0.95–0.99) were associated with mortality or morbidity.

Conclusion Lower nursing provision ratio calculated using the WANNNT and CNRU during the first 7 days of admission is associated with an increased risk of mortality/morbidity in very preterm infants.

Key Points

  • NICUs use different nursing workload assessment tools.

  • We validated three different nursing workload assessment tools used in the NICU.

  • Nursing provision ratio is associated the risk of mortality/morbidity in preterm infants.

Keywords

nurse staffing - health care organization - infant - neonatal intensive care unit

Supplementary Material



Publication History

Received: 30 May 2020

Accepted: 01 September 2020

Article published online:
14 October 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Beltempo M, Blais R, Lacroix G, Cabot M, Piedboeuf B. Association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections in the NICU. Am J Perinatol 2017; 34 (10) 996-1002
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Sherenian M, Profit J, Schmidt B. et al. Nurse-to-patient ratios and neonatal outcomes: a brief systematic review. Neonatology 2013; 104 (03) 179-183
    CrossrefPubMedGoogle Scholar
  • 3 Sawatzky-Dickson D, Bodnaryk K. Validation of a tool to measure neonatal nursing workload. J Nurs Manag 2009; 17 (01) 84-91
    CrossrefPubMedGoogle Scholar
  • 4 Beltempo M, Lacroix G, Cabot M, Blais R, Piedboeuf B. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants. J Perinatol 2018; 38 (02) 175-180
    CrossrefPubMedGoogle Scholar
  • 5 Shah PS, Mirea L, Ng E, Solimano A, Lee SK. Canadian Neonatal Network. Association of unit size, resource utilization and occupancy with outcomes of preterm infants. J Perinatol 2015; 35 (07) 522-529
    CrossrefPubMedGoogle Scholar
  • 6 Shahroor M, Lehtonen L, Lee SK. et al; on behalf of the International Network for Evaluation of Outcomes (iNeo) of neonates. Unit-level variations in healthcare professionals' availability for preterm neonates <29 weeks' gestation: an international survey. Neonatology 2019; 116 (04) 347-355
    CrossrefPubMedGoogle Scholar
  • 7 Junttila JK, Koivu A, Fagerström L, Haatainen K, Nykänen P. Hospital mortality and optimality of nursing workload: a study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system. Int J Nurs Stud 2016; 60: 46-53
    CrossrefPubMedGoogle Scholar
  • 8 Fasoli DR, Fincke BG, Haddock KS. Going beyond patient classification systems to create an evidence-based staffing methodology. J Nurs Adm 2011; 41 (10) 434-439
    CrossrefPubMedGoogle Scholar
  • 9 Medicine BAoP. Service standards for hospitals providing neonatal care, BAPM London. Accessed August 31, 2010 at: https://www.bapm.org/resources/32-service-standards-for-hospitals-providing-neonatal-care-3rd-edition-2010
    PubMedGoogle Scholar
  • 10 Network CN. The Canadian Neonatal Network Abstractor's Manual v2.1.2. Toronto, CNN. Accessed 2014 at: http://www.canadianneonatalnetwork.org/portal/
    PubMedGoogle Scholar
  • 11 Kramer MS, Platt RW, Wen SW. et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (02) E35
    CrossrefPubMedGoogle Scholar
  • 12 Beltempo M, Shah PS, Ye XY, Afifi J, Lee S, McMillan DD. Canadian Neonatal Network Investigators. SNAP-II for prediction of mortality and morbidity in extremely preterm infants. J Matern Fetal Neonatal Med 2019; 32 (16) 2694-2701
    CrossrefPubMedGoogle Scholar
  • 13 Lee SK, Beltempo M, McMillan DD. et al; Evidence-based Practice for Improving Quality Investigators. Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study. CMAJ 2020; 192 (04) E81-E91
    CrossrefPubMedGoogle Scholar
  • 14 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 15 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (04) 527-532
    CrossrefPubMedGoogle Scholar
  • 16 Gole GA, Ells AL, Katz X. et al; International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
    CrossrefPubMedGoogle Scholar
  • 17 Papile L-A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
    CrossrefPubMedGoogle Scholar
  • 18 Pediatrics AAo, Obstetricians ACo, Gynecologists. Guidelines for Perinatal Care, 7th. American Academy of Pediatrics; Elk Grove Village, IL: 2007
    Google Scholar
  • 19 Rogowski JA, Staiger DO, Patrick TE, Horbar JD, Kenny MJ, Lake ET. Nurse staffing in neonatal intensive care units in the United States. Res Nurs Health 2015; 38 (05) 333-341
    CrossrefPubMedGoogle Scholar
  • 20 Isayama T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA 2016; 316 (06) 611-624
    CrossrefPubMedGoogle Scholar
  • 21 Murthy P, Zein H, Thomas S. et al. Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants. Pediatr Neurol 2020; 110: 42-48
    CrossrefPubMedGoogle Scholar
  • 22 Lee SK, Beltempo M, McMillan DD. et al. Outcomes and care practices of preterm infants in Canada: 12 years of quality improvement. Pediatr Academic Societies DOI: 10.1503/cmaj.2018.
    CrossrefPubMedGoogle Scholar
  • 23 Rogowski JA, Staiger D, Patrick T, Horbar J, Kenny M, Lake ET. Nurse staffing and NICU infection rates. JAMA Pediatr 2013; 167 (05) 444-450
    CrossrefPubMedGoogle Scholar
  • 24 Lamy Filho F, Silva AA, Lopes JM, Lamy ZC, Simões VM, Dos Santos AM. Staff workload and adverse events during mechanical ventilation in neonatal intensive care units. J Pediatr (Rio J) 2011; 87 (06) 487-492
    PubMedGoogle Scholar
  • 25 Hamilton KES, Redshaw ME, Tarnow-Mordi W. Nurse staffing in relation to risk-adjusted mortality in neonatal care. Arch Dis Child Fetal Neonatal Ed 2007; 92 (02) F99-F103
    CrossrefPubMedGoogle Scholar
  • 26 Tubbs-Cooley HL, Mara CA, Carle AC, Mark BA, Pickler RH. Association of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit. JAMA Pediatr 2019; 173 (01) 44-51
    CrossrefPubMedGoogle Scholar
  • 27 Sink DW, Hope SAE, Hagadorn JI. Nurse:patient ratio and achievement of oxygen saturation goals in premature infants. Arch Dis Child Fetal Neonatal Ed 2011; 96 (02) F93-F98
    CrossrefPubMedGoogle Scholar
  • 28 Boland RA, Davis PG, Dawson JA, Doyle LW. Victorian Infant Collaborative Study Group. Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia. Arch Dis Child Fetal Neonatal Ed 2013; 98 (03) F201-F204
    CrossrefPubMedGoogle Scholar
  • 29 Johnson TJ, Patel AL, Jegier BJ, Engstrom JL, Meier PP. Cost of morbidities in very low birth weight infants. J Pediatr 2013; 162: 243-249.e241
    CrossrefPubMedGoogle Scholar