Studying the effects of nursing staff levels and practice environments on low-birthweight mortality, morbidity, failure to rescue and length of stay

This investigator-initiated project aims to measure acuity-adjusted nurse staffing levels and nursing practice environments in the NICU and to study their effects on very low birth weight infant mortality, morbidity, failure-to-rescue and length of stay. VLBW infants are among the highest-risk patient populations. These infants are treated in NICUs where they are closely monitored and receive life support measures and intensive interventions. While they account for only 1percent of births, VLBW infants account for half of infant deaths each year. VLBW infants suffer from common morbidities: nosocomial infection, chronic lung disease and intraventricular hemorrhage (IVH). These morbidities increase the risks for death, long-term disability, and increase the duration and cost of hospitalization. Large variations in outcomes exist across NICUs that cannot be explained by patient or NICU differences. Since NICU cases are among the most nurse-intensive hospitalizations, nursing holds promise for explaining the variations and for improving the outcomes of these high-risk infants. This observational study will be conducted in 50 NICUs that are members of the Vermont Oxford Network, a voluntary, collaborative network that contains over half of the NICUs in the U.S. They will collect nurse survey data and to match those data to abstracted infant medical record data. Nurse staffing and infant acuity data will be used to estimate acuity weights in regression models. Measures of the nursing practice environment will be aggregated to the nursing unit level from nurse survey responses. Six outcomes will be measured at the infant level: death within 28 days, nosocomial infection, chronic lung disease, IVH, failure-to-rescue and length of stay. They will use random effects logit models and OLS robust regression models to estimate the effects of nursing factors on infant outcomes.

Grant Details

Amount Awarded $299,685.00

Awarded on: 7/30/2007

Time frame: 9/1/2007 - 8/31/2009

Grant Number: 62601


University of Pennsylvania School of Nursing

Fagan Hall
418 Curie Boulevard
Philadelphia, 19104-4217


Eileen T. Lake
Project Director