12206 (601) The Three Es: How Neonatal Staff Nurses' Education, Experience and Environments Impact Infant Outcomes
Thelma Patrick, PhD RN

Abstract
PURPOSE OF THE STUDY: In this first large-scale U.S. study of nursing effects on NICU outcomes, we examine whether variation in acuity-adjusted nurse staffing and environments contribute to the variation in NICU patient outcomes.

STUDY DESIGN: Patient acuity and practice environment data were collected in March 2008 via web survey from 6400 nurses from 104 NICUs. Variables were the observed to expected nurse-to-infant ratio for each unit, descriptors of the nursing staff (education, certification, experience), ANCC magnet status, practice environment as measured by the Practice Environment Scale of the Nursing Workforce Index, and selected infant outcomes from the VON database for 2007 (N=8490). Patient characteristics, including gestational age, 1-minute APGAR score, race, gender, and prenatal care were included as control variables.

POPULATION STUDIED: Very low birthweight infants in NICUs Findings: The proportions of staff with BSNs, ≥5 years of nursing experience, and neonatal specialty certification, were 56%, 74% and 19% respectively. Hospitals with BSN prepared, more NICU-experienced nurses, staffed at lower levels. Average outcome rates were mortality, 11%, nosocomial infection, 17%, and severe intraventricular hemorrhage (SIVH), 7%. Nurse staffing, proportion of BSNs, and magnet status were significantly associated with mortality. Infants in the most professional practice environments had lower odds of infection, and infants in units with more experienced NICU nurses had lower odds of SIVH.

CONCLUSIONS: Nurse staffing and environments explain some of the variation in neonatal outcomes across NICUs. Bachelor's-prepared nurses and more NICU-experienced nurses are more efficiently able to care for VLBW infants.

Learning Objectives

1. Describe the history and purpose of the study of nursing effects on NICU infant outcomes.
2. Review the relevant literature regarding nurse staffing, nurse characteristics, practice environments, and infant outcomes.
3. Describe the methods used to study the effects of nurse staffing, nurse characteristics, and practice environment on infant outcomes.
4. Cite the major findings of the study of nursing effects on NICU outcomes.
5. State the conclusions of the study, identify future steps for the study team, and pose questions related to the study process, outcomes, and potential for the future.

Bibliography
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Cimiotti, J. P., Haas, J., Saiman, L., & Larson, E. L. (2006). Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med, 160(8), 832-836.

Blegen, M. A., Vaugh, T., & Vojir, C. P. (2008) Nurse staffing levels: impact of organizational characteristics and registered nurse supply. Health Service Research 43: 154-173.

Sales, A., et al. (2008) The association between nursing factors and patient mortality in the Veterans Health Administration: the view from the nursing unit level. Medical Care 46: 938-945.

Stone, P. W., et al. (2007) Nurse working conditions and patient safety outcomes. Medical Care 45: 571-578.