Study shows missed nursing care is a key factor in adverse outcomes for very low birthweight infants

PHILADELPHIA (January 24, 2023) – Sometimes hospital staff nurses cannot provide required care due to time constraints. This reality can contribute to potentially dire outcomes for very low birthweight (VLBW) infants, who weigh less than 3.3 lbs. at birth. These newborns depend on the nurse for survival. Missed nursing care is likely clinically relevant to whether VLBW infants develop an infection, develop a brain hemorrhage, or even die. Given post-pandemic staffing shortages and the increased burden placed on nurses, routine measurement of missed care and managerial efforts to prevent it could be vital to improving the health and life course of VLBW infants.

In a novel study of 190 hospitals throughout the United States, researchers from the University of Pennsylvania School of Nursing (Penn Nursing) have discovered that on nursing units where nurses miss more required care, VLBW infants have higher odds of bloodstream infection and longer lengths of stay. A bloodstream infection is a very serious outcome. It doubles the risk of dying for VLBW infants.

“When the nurse is not able to complete the full scope of required care, this can lead to poorer nurse-sensitive health outcomes, including bloodstream infections and longer lengths of stay,” says lead-author Eileen T. Lake, PhD, RN, FAAN, the Edith Clemmer Steinbright Professor in Gerontology, Professor of Nursing, and Associate Director of the Center for Health Outcomes and Policy Research. “Because of the complexity of care required by VLBW infants, their fragile health status, and their anatomic, physiologic and immunologic immaturity, they simultaneously have a high risk for adverse outcomes and a low tolerance for poor care processes.”

The researchers found that one-quarter of nurses reported having missed a clinical requirement on the prior shift. The researchers previously documented that nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. According to Lake, “The combined evidence sends a clear picture to hospital administrators and neonatal intensive care unit managers to remedy insufficient staffing and unsupportive work environments.”

The article “The Association of Missed Nursing Care With Very Low Birthweight Infant Outcomes” details the study. It has been published in the journal Medical Care Research and Review and is available online. Co-authors include Douglas Staiger, Dartmouth College, Jessica G. Smith, University of Texas Arlington, and Jeannette A. Rogowski, Pennsylvania State University. The research was funded by the Agency for Healthcare Research and Quality R01 HS 024918 (Lake PI). The authors thank Morgan Peele for her analytic support. The National Database of Nursing Quality Indicators (NDNQI) data were supplied by Press Ganey Associates, Inc. Press Ganey Associates, Inc. specifically disclaims responsibility for any analyses, interpretations, or conclusions.

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About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing. For the seventh year in a row, it is ranked the #1 nursing school in the world by QS University. In a first for any undergraduate Bachelor of Science in Nursing (BSN) program in the country, our BSN program is ranked # 1 in the 2022 U.S. News & World Report’s Best Colleges rankings. Penn Nursing is also consistently ranked highly in the U.S. News & World Report annual list of best graduate schools and is ranked as one of the top schools of nursing in funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram.