Study shows missed nursing care is a key factor in adverse outcomes for very low birthweight infants

Sometimes hospital staff nurses cannot provide required care due to time constraints. This reality can contribute to potentially dire outcomes for very low birthweight (VLBW) infants, who weigh less than 3.3 lbs. at birth.

These newborns depend on the nurse for survival. Missed nursing care is likely clinically relevant to whether VLBW infants develop an infection, develop a brain hemorrhage, or even die. Given post-pandemic staffing shortages and the increased burden placed on nurses, routine measurement of missed care and managerial efforts to prevent it could be vital to improving the health and life course of VLBW infants.

In a novel study of 190 hospitals throughout the United States, researchers from the University of Pennsylvania School of Nursing (Penn Nursing) have discovered that on nursing units where nurses miss more required care, VLBW infants have higher odds of bloodstream infection and longer lengths of stay. A bloodstream infection is a very serious outcome. It doubles the risk of dying for VLBW infants.

"When the nurse is not able to complete the full scope of required care, this can lead to poorer nurse-sensitive health outcomes, including bloodstream infections and longer lengths of stay," says lead-author Eileen T. Lake, Ph.D., RN, FAAN, the Edith Clemmer Steinbright Professor in Gerontology, Professor of Nursing, and Associate Director of the Center for Health Outcomes and Policy Research.

"Because of the complexity of care required by VLBW infants, their fragile health status, and their anatomic, physiologic and immunologic immaturity, they simultaneously have a high risk for adverse outcomes and a low tolerance for poor care processes."

The researchers found that one-quarter of nurses reported having missed a clinical requirement on the prior shift. The researchers previously documented—in a study published in Medical Care Research and Review in 2018—that nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care.

According to Lake, "The combined evidence sends a clear picture to hospital administrators and neonatal intensive care unit managers to remedy insufficient staffing and unsupportive work environments."

The new findings are also published in Medical Care Research and Review.