为领导模式提供信息：独立儿童医院新生儿重症监护病房的护理与组织特征

Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

作者信息

Toole Cheryl A, DeGrazia Michele, Connor Jean Anne, Gauvreau Kimberlee, Kuzdeba Hillary Bishop, Hickey Patricia A

机构信息

Cheryl A. Toole, MS, RN, CCRN, NEA-BC, is director of nursing patient services, Neonatal Intensive Care Unit, Cardiovascular and Critical Care Nursing and Patient Services, Boston Children's Hospital, Massachusetts. Michele DeGrazia, PhD, RN, NNP-BC, FAAN, is director of nursing research, Neonatal Intensive Care Unit, Cardiovascular and Critical Care Nursing and Patient Services, Boston Children's Hospital; and assistant professor, Pediatrics Harvard Medical School, Boston, Massachusetts. Jean Anne Connor, PhD, RN, CPNP, FAAN, is director of nursing research, Cardiovascular and Critical Care Nursing and clinical instructor, Pediatrics Patient Services, Boston Children's Hospital, Massachusetts. Kimberlee Gauvreau, ScD, is senior biostatistician, Department of Cardiology, Boston Children's Hospital; and Harvard Medical School, Boston, Massachusetts. Hillary Bishop Kuzdeba, MPH, is program coordinator, Cardiovascular and Critical Care Nursing and Patient Services, Boston Children's Hospital, Massachusetts. Patricia A. Hickey, PhD, MBA, RN, NEA-BC, FAAN, is vice president and associate chief nursing officer, Cardiovascular and Critical Care Nursing and Patient Services, Boston Children's Hospital; and assistant professor, Pediatrics Harvard Medical School, Boston, Massachusetts.

出版信息

Dimens Crit Care Nurs. 2018 May/Jun;37(3):156-166. doi: 10.1097/DCC.0000000000000296.

DOI:10.1097/DCC.0000000000000296

PMID:29596292

Abstract

BACKGROUND

Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes.

OBJECTIVES

Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States.

METHODS

Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics.

RESULTS

The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists.

CONCLUSION

This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.

摘要

背景

独立儿童医院的新生儿重症监护病房（NICU）在护理和组织特征方面可能存在显著差异，这可为合作提供契机，以了解最佳人员配置模式及其与患者预后的关联。

目的

采用希基等人在儿科心血管重症监护中使用的方法，本研究旨在对美国独立儿童医院的NICU的护理和组织特征进行基础描述。

方法

邀请独立儿童医院NICU的临床护士领导参与电子横断面调查。采用描述性分析总结护理和组织特征。

结果

回复率为30%（13/43），69.2%的NICU被归类为三级/四级，30.8%被归类为二级/三级。许可床位容量差异显著（范围为24 - 167），全职等效护士的比例也如此（范围为71.78 - 252.3）。约四分之三的注册护士拥有学士学位或更高学位。四分之一的护士有16年或更长时间（26.3%）的工作经验，36.9%的护士有11年或更长时间的护理经验。近三分之一（29.2%）的护士总护理经验为5年或更少。持有新生儿专科认证的护士很少（10.6%）。所有单位都有护士教育工作者、国家和单位层面的质量指标以及程序检查表。