News Release

More Nursing Time Means Better Outcomes for Children

CHAPEL HILL – Children have better outcomes after surgery in hospitals with high nurse staffing levels, where registered nurses provide more hours of care, according to researchers from the University of North Carolina at Chapel Hill School of Nursing.

In the first large-scale study to look at the relationship between nurse staffing and the quality of care for hospitalized children, the researchers discovered that having registered nurses provide more hours of care noticeably reduced negative outcomes following surgery, including heart and lung complications, pneumonia and blood stream infections.

“Better nurse staffing in hospitals simply means that kids fare better” said Barbara Mark, Ph.D., Sarah Frances Russell professor in nursing systems in the UNC School of Nursing and the study’s principal investigator. “These findings show the need for hospitals to have enough nurses to provide optimal care to our youngest patients.”

The study was published in the current issue of the journal Policy, Politics & Nursing Practice and is available online at http://ppn.sagepub.com. The federally-funded Agency for Healthcare Research and Quality sponsored the study.

Although there is not enough data to get an accurate picture of how often these complications occur in the general pediatric patient population, Mark said, it is clear that children who experience complications have longer hospital stays, higher death rates and higher hospital costs.

The study, which reviewed discharge records of 3.65 million pediatric patients in 286 hospitals in California, found that hospitals could potentially have reduced the number of negative outcomes by increasing the hours of care provided by registered nurses.

The largest predicted reductions in complications were at hospitals with the lowest levels of staffing, where heart and lung (cardiopulmonary) complications were predicted to decline by 4.4 percent following surgery. Pneumonia and blood stream infections that develop after surgery were also predicted to drop by 2.3 percent and 3.8 percent, respectively. While hospitals with relatively high levels of staffing potentially could also have reduced complications by improving their staffing, the reductions were lower: 3.1 percent fewer children would have experienced cardiopulmonary problems, 1.7 percent fewer would have developed pneumonia and 3.4 percent fewer would have contracted a blood stream infection.

The findings indicate that with increased staffing hours at the California hospitals included in the study, between 425 and 596 children could have avoided a cardiopulmonary complication after surgery. In addition, 95 to 124 might not have gotten pneumonia, and between 719 and 787 could have avoided a blood stream infection. 

In addition to pointing to a decrease in negative outcomes, the findings are also a message to the healthcare community and parents or guardians of children who are or will be hospitalized, Mark said. The results are evidence, she said, that children, like adults, experience more positive results when registered nurses provide more care. She also said steps should be taken to ensure that there is a sufficient supply of nurses in the labor pool to adequately staff hospitals.

Parents or guardians, she said, must be more proactive about a child’s healthcare.

“To the extent possible, parents and guardians of a child should try to obtain information about the staffing policies at the hospital where their child will be a patient,” Mark said. “It’s in the child’s best interest to find out. Getting that information isn’t always easy, but it’s getting easier now that more states are making the policies a matter of public record.”

Co-authors on the study include David W. Harless, Ph.D., Virginia Commonwealth University, and Wallace F. Berman, M.D., Duke University Medical Center. 

School of Nursing contact: Whitney Howell, (919) 966-4619, whitney_howell@unc.edu
News Services contact: Becky Oskin, (919) 962-8596, becky_oskin@unc.edu