Sheahan Kelsey H, Kennedy Amanda G, Tompkins Bradley J, Repp Allen B, Gilbert Matthew P
Endocrinology, Northwestern Medical Center, St. Albans, USA.
Larner College of Medicine, University of Vermont, Burlington, USA.
Cureus. 2021 Jun 29;13(6):e16020. doi: 10.7759/cureus.16020. eCollection 2021 Jun.
Introduction Hyperglycemia and hypoglycemia have been found to increase morbidity and mortality among hospitalized patients with diabetes. In July of 2018, our academic medical center experienced a 48-hour nursing strike, during which time 600 replacement nurses were employed. This cohort study evaluated the impact of the nursing strike on glycemic control among hospitalized patients with diabetes. Methods Point-of-care fingerstick blood glucose (POC BG) values among hospitalized patients with diabetes were compared between the 48-hour nursing strike period and two 48-hour periods when the nursing strike did not occur. We evaluated the percentage of POC BG values that were hyperglycemic (POC BG 181-250 mg/dL), severely hyperglycemic (POC BG >250 mg/dL), and hypoglycemic (POC BG <70 mg/dL). Additionally, we assessed the proportion of patients who experienced one or more days of hypoglycemia, hyperglycemia, or severe hyperglycemia. Results We found a significant association between the distributions of POC BG test results during the nursing strike; test results more frequently showed hyperglycemia, severe hyperglycemia, or hypoglycemia during the nursing strike than during the control period (p=0.006). There was a significant difference in the days of hypoglycemia, with 7.7% of patients experiencing one or more days of hypoglycemia during the strike period compared with 1.4% of patients during the control period (p=0.03). Conclusion Nursing strikes have been employed as a last resort in contract negotiations with hospitals, but they have the potential to significantly affect patient care and safety. Further studies are needed to evaluate these impacts to prepare for future workforce disruptions.
引言 已发现高血糖和低血糖会增加糖尿病住院患者的发病率和死亡率。2018年7月，我们的学术医疗中心经历了一次为期48小时的护士罢工，在此期间雇佣了600名替代护士。这项队列研究评估了护士罢工对糖尿病住院患者血糖控制的影响。方法 比较了糖尿病住院患者在48小时护士罢工期间以及未发生护士罢工的两个48小时期间的即时指尖血糖（POC BG）值。我们评估了高血糖（POC BG 181 - 250 mg/dL）、严重高血糖（POC BG >250 mg/dL）和低血糖（POC BG <70 mg/dL）的POC BG值百分比。此外，我们评估了经历一天或多天低血糖、高血糖或严重高血糖的患者比例。结果 我们发现护士罢工期间POC BG检测结果的分布之间存在显著关联；与对照期相比，罢工期间检测结果更频繁地显示高血糖、严重高血糖或低血糖（p = 0.006）。低血糖天数存在显著差异，罢工期间7.7%的患者经历了一天或多天低血糖，而对照期为1.4%的患者（p = 0.03）。结论 护士罢工已被用作与医院进行合同谈判的最后手段，但它们有可能显著影响患者护理和安全。需要进一步研究来评估这些影响，为未来的劳动力中断做好准备。
