Abstract 1458 Poster Session III, Monday, 5/3 (poster 63)

BACKGROUND: Nursing is the single largest item of cost in the NICU. Recent cutbacks in provincial health care budgets have caused an apparent shortage of nurses at Canadian hospitals. To examine the impact of cutbacks on NICU nurse staffing, we assessed the adequacy and efficiency of nurse staffing at four Canadian NICUs, and their association with patient outcomes. We also assessed correlation between illness severity and nursing workload.

METHOD: Daily recommended (estimated using Medicus nursing workload index) and actual nurse hours utilized were obtained retrospectively from participating NICUs during 1996, and transformed into full-time equivalent nurses working an 8-hour shift. Purely administrative nurse positions were excluded. Nurse staffing adequacy was assessed using the variance of actual from recommended nursing utilization. Nurse staffing efficiency was assessed by examining the correlation over time between recommended and actual nurse utilization. Mortality and infection rates were compared between NICUs for possible association with mortality, >grade 3 intraventricular hemorrhage (IVH) and infection rates. Using individual patient data, day 1 SNAP-II scores were correlated with Medicus and Grasp nursing workload scores.

RESULTS: 1 NICU had a mean shortage of 1.49 nurses (95%CI: -1.64 to -1.35), 1 NICU had a mean excess of 1.43 nurses (95%CI: 1.31 to 1.55), and the remaining 2 NICUs were appropriately staffed. All 4 NICUs demonstrated high efficiency at staffing their NICUs according to nurse workload. There was no consistent seasonal pattern in nurse workload among the NICUs. There was no association between nursing shortage/excess and increased/decreased patient outcomes (mortality, infection). Illness severity (SNAPPE-II) was significantly (p<0.01) correlated with Medicus (Pearson 0.22) and Grasp (Pearson 0.44).

CONCLUSION: Despite recent health care cutbacks, most of the Canadian hospitals examined in this study were able to adequately staff their NICUs with nurses, and are highly efficient at managing their nursing resources, with no discernible adverse impact on patient outcomes. Illness severity is correlated with nursing workload and can potentially be developed as an instrument to assess nursing workload.

Funded by the Medical Research Council of Canada