Rogowski Jeannette A, Staiger Douglas O, Patrick Thelma E, Horbar Jeffrey D, Kenny Michael J, Lake Eileen T
Rutgers, The State University of New Jersey, New Brunswick, NJ.
Dartmouth College, Hanover, NH.
Res Nurs Health. 2015 Oct;38(5):333-41. doi: 10.1002/nur.21674. Epub 2015 Aug 20.
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009-2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting.
新生儿重症监护病房（NICU）是护士与患者比例很高的场所。对于决定护士工作量和任务分配的因素，我们知之甚少。本研究的目的是：（1）制定一种NICU婴儿病情严重程度的测量方法；（2）描述NICU婴儿的病情严重程度分布情况；（3）描述每个病情严重程度级别的护士与婴儿比例，并研究除病情严重程度之外的其他因素，包括护士资质以及医生和其他医护人员的可获得性，这些因素决定了人员配备比例；（4）探讨护士资质是否与所分配婴儿的病情严重程度相关。在一项两阶段队列研究中，2008年通过护士调查（6038名护士及其负责的15191名婴儿）在104个NICU收集了数据，管理人员报告了非护士医护人员的单位级人员配备情况；在2009 - 2010年70个NICU的子集中，收集了四个选定班次的普查数据（3871名护士及其负责的9276名婴儿）。大多数NICU婴儿（62%）病情严重程度较低（1级和2级）；12%的婴儿病情严重程度较高（4级和5级）。护士与婴儿的比例从病情严重程度最低的婴儿的0.33到病情严重程度最高的婴儿的0.95不等。人员配备比例与所分配婴儿的病情严重程度显著相关，但与护士教育程度、经验、资质认证或其他医护人员的可获得性无关。分配给具有专业资质认证护士的病情严重程度较高（4级和5级）婴儿的百分比存在显著但较小的差异（有资质认证的护士为15%，无资质认证的护士为12%）。在这种高度密集的儿科护理环境中，这些人员配备模式可能无法使患者获得最佳治疗效果。
