Monday, July 20, 2009

Neonatal ICU is Not the Place to Find Labor Savings

Today, Modern Healthcare posted a commentary by INQRI grantees Eileen Lake and Thelma Patrick on their research on neonatal intensive care units (NICU). They argue that by fully staffing a NICU with sufficiently-seasoned nurses and by developing an environment in which nurses work as a team with doctors, hospitals can reduce the number of hospital-acquired infections (HAI) in these tiny babies.

See below for an excerpt from the article.

What's a NICU with inadequate support for nurses? We define it as a unit that comes up short when itcomes to staffing and other resources. Nurses on such units are often caring for too many critically ill infants. In addition, they're often pulled away from direct nursing care and are juggling too many non-nursing duties, like answering the phone, running to pick up a prescription or transporting a patient. A suboptimal unit is also one where nurses' authority doesn't match their responsibility. When they speak up with an urgent concern about a tiny baby, they may not get a rapid response or credit for their assessment. In some cases, nurses delay calling doctors because they're concerned about getting an angry response: Over time, such strained relationships can lead to inefficient or suboptimal care. NICU babies, especially the very tiny ones, often need constant nursing care just to prevent complications like infections or bleeding in the brain. But hospital managers struggling to stay afloat in a deepening recession might be tempted to cut nursing staff or other services…

…So what should hospitals do? CEOs should fully staff the NICU and other hospital service units so that nurses aren't called away from a critically ill infant to answer the phone. Fully staffing a NICU might mean hiring more registered nurses to make sure that critically ill infants have one-on-one nursing care. Or managers might have to keep support staff, like secretaries, on duty—even at night or on the weekend. Hospitals should also make sure that they don't leave lots of relatively young nurses on duty without support, including a seasoned supervisor. Without adequate supervision, a short-staffed young nurse might turn too quickly from one very sick newborn to another—and fail to wash up. That one misstep could spread a lethal bug from one baby to the next. Managers must also work to create a professional atmosphere in the NICU so that nurses and doctors work together as a team. They must include nurses in hospital rounds and encourage nurses to speak up when they have concerns about a patient.

For full text, see here.

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