NICU Nursing Care Problems Linked To Workload, Pressures: Study

How difficult a nurse working in neonatal intensive care units (NICU) perceives his or her job to be is directly linked to the quality of patient care, according to the findings of a new study. 

Nurses who perceived their job to be more difficult during a specific shift, or who are under more mental pressure during that shift, tend to miss more instances of necessary patient care, according findings published in the medical journal JAMA Pediatrics November 12. The study found that the nurses’ perceptions of difficulty and stress had more of an effect than the actual ratio of nurses to patients in a hospital unit.

Researchers from Ohio State University, Cincinnati Children’s Hospital Medical Center, and the University of Cincinnati studied 136 nurses caring for 418 infants during 332 nurse shifts lasting 12 hours each. The study was conducted at a 52-bed level IV NICU in a Midwestern academic medical center from March 1, 2013, through January 31, 2014.

Nurses self-reported the care conducted during each shift of individual infants whose medical data were taken from electronic health records. Nurses filled out a questionnaire that measured their perceived workload, the physical demand, how hurried they felt, and the overall effort needed to accomplish patient care for each shift.

Nurses who perceived their duties to be more strenuous or difficult were more likely to miss care for patients during that shift. Similarly, nurses caring for three or more infants were 2.5 times more likely to report missing care during the shift if they self-reported the job was difficult during that shift.

The perceived level of pressure and difficulty is just as important to consider regarding patient care as other factors, the researchers determined. Increased subjective workload was consistently associated with increased missed care for patients.

A nurse’s perception of the difficulty of the workday was important to whether they were able to keep up with the care of their patients, regardless of how many patients the nurse was tending. This included being rushed and mental pressures of the job.

Activities that were commonly missed included hourly assessments of the intravenous sites, oral feedings, collection of laboratory results, and safety checks of equipment and alarms. These are all tasks that can lead to serious outcomes when missed.

The findings also indicated that increased infant-to-nurse ratio during a shift was also associated with increased missed nursing care in about half of the measured missed care items. This is a factor that has been shown in other studies.

However, the subjective workload of a nurse was the one factor that was “consistently and strongly” associated with missed care for a patient.