News Reader.info

ABSTRACT OBJECTIVE: To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the

risk of mortality or major morbidity among very preterm infants. STUDY DESIGN: Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth

weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing

hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association

with the composite outcome (mortality or major morbidity). RESULTS: Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted

multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval

(CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU

occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also

associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). CONCLUSION: High nursing provision ratio during NICU hospitalization is associated with a lower risk

of a composite adverse outcome in very preterm infants. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS

Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on

SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about

institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS NEONATAL INTENSIVE CARE UNIT OCCUPANCY RATE AND PROBABILITY OF DISCHARGE OF VERY

PRETERM INFANTS Article 06 January 2023 THE IMPACT OF VOLUME AND NEONATAL LEVEL OF CARE ON OUTCOMES OF MODERATE AND LATE PRETERM INFANTS Article 27 February 2024 HOSPITAL VARIATION IN

ADMISSIONS TO NEONATAL INTENSIVE CARE UNITS BY DIAGNOSIS SEVERITY AND CATEGORY Article 14 August 2020 REFERENCES * Shah PS, Lui K, Sjors G, Mirea L, Reichman B, Adams M _et al_. Neonatal

outcomes of very low birth weight and very preterm neonates: an international comparison. _J Pediatr_ 2016; 177: 144–152.e146. Article  Google Scholar  * Stoll BJ, Hansen NI, Bell EF, Walsh

MC, Carlo WA, Shankaran S _et al_. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. _JAMA_ 2015; 314 (10): 1039–1051. Article  CAS  Google Scholar

  * Chen F, Bajwa NM, Rimensberger PC, Posfay-Barbe KM, Pfister RE . Thirteen-year mortality and morbidity in preterm infants in Switzerland. _Arch Dis Child Fetal Neonatal Ed_ 2016; 101

(5): F377–F383. Article  Google Scholar  * Watson SI, Arulampalam W, Petrou S, Marlow N, Morgan AS, Draper ES _et al_. The effects of a one-to-one nurse-to-patient ratio on the mortality

rate in neonatal intensive care: a retrospective, longitudinal, population-based study. _Arch Dis Child Fetal Neonatal Ed_ 2016; 101 (3): F195–F200. Article  CAS  Google Scholar  * Rogowski

JA, Staiger DO, Patrick TE, Horbar JD, Kenny MJ, Lake ET . Nurse staffing in neonatal intensive care units in the United States. _Res Nurs Health_ 2015; 38 (5): 333–341. Article  Google

Scholar  * Drebit S, Ngan K, Hay M, Alamgir H . Trends and costs of overtime among nurses in Canada. _Health Policy_ 2010; 96 (1): 28–35. Article  Google Scholar  * Canadian Association of

Paediatric Health Care Centers-Canadian Paediatric Decision Support NetworkBenchmarking report 2013. Ottawa, ON, Canada; 2013. * Berney B, Needleman J . Trends in nurse overtime, 1995–2002.

_Policy Polit Nurs Pract_ 2005; 6 (3): 183–190. Article  Google Scholar  * Berney B, Needleman J . Impact of nursing overtime on nurse-sensitive patient outcomes in New York hospitals,

1995–2000. _Policy Polit Nurs Pract_ 2006; 7 (2): 87–100. Article  Google Scholar  * Cimiotti JP, Aiken LH, Sloane DM, Wu ES . Nurse staffing, burnout, and health care-associated infection.

_Am J Infect Control_ 2012; 40 (6): 486–490. Article  Google Scholar  * Trinkoff AM, Le R, Geiger-Brown J, Lipscomb J, Lang G . Longitudinal relationship of work hours, mandatory overtime,

and on-call to musculoskeletal problems in nurses. _Am J Ind Med_ 2006; 49 (11): 964–971. Article  Google Scholar  * Bae SH, Fabry D . Assessing the relationships between nurse work

hours/overtime and nurse and patient outcomes: systematic literature review. _Nurs Outlook_ 2014; 62 (2): 138–156. Article  Google Scholar  * Stone PW, Mooney-Kane C, Larson EL, Horan T,

Glance LG, Zwanziger J _et al_. Nurse working conditions and patient safety outcomes. _Med Care_ 2007; 45 (6): 571–578. Article  Google Scholar  * Olds DM, Clarke SP . The effect of work

hours on adverse events and errors in health care. _J Safety Res_ 2010; 41 (2): 153–162. Article  Google Scholar  * Trinkoff AM, Johantgen M, Storr CL, Gurses AP, Liang Y, Han K .

Nurses' work schedule characteristics, nurse staffing, and patient mortality. _Nurs Res_ 2011; 60 (1): 1–8. Article  Google Scholar  * Rogowski JA, Staiger D, Patrick T, Horbar J, Kenny

M, Lake ET . Nurse staffing and NICU infection rates. _JAMA Pediatr_ 2013; 167 (5): 444–450. Article  Google Scholar  * Sherenian M, Profit J, Schmidt B, Suh S, Xiao R, Zupancic JA _et al_.

Nurse-to-patient ratios and neonatal outcomes: a brief systematic review. _Neonatology_ 2013; 104 (3): 179–183. Article  Google Scholar  * Hamilton KE, Redshaw ME, Tarnow-Mordi W . Nurse

staffing in relation to risk-adjusted mortality in neonatal care. _Arch Dis Child Fetal Neonatal Ed_ 2007; 92 (2): F99–F103. Article  Google Scholar  * Callaghan LA, Cartwright DW,

O'Rourke P, Davies MW . Infant to staff ratios and risk of mortality in very low birthweight infants. _Arch Dis Child Fetal Neonatal Ed_ 2003; 88 (2): F94–F97. Article  CAS  Google

Scholar  * Grandi C, Gonzalez A, Meritano J . Patient volume, medical and nursing staffing and its relationship with risk-adjusted outcomes of VLBW infants in 15 Neocosur neonatal network

NICUs. _Arch Argent Pediatr_ 2010; 108 (6): 499–510. PubMed  Google Scholar  * Tucker J . Group UKNSS. Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a

random stratified sample of UK neonatal intensive care units: a prospective evaluation. _Lancet_ 2002; 359 (9301): 99–107. Article  Google Scholar  * Shah PS, Mirea L, Ng E, Solimano A, Lee

SK Canadian Neonatal Network. Association of unit size, resource utilization and occupancy with outcomes of preterm infants. _J Perinatol_ 2015; 35 (7):522–529. Article  CAS  Google Scholar

  * Berney B, Needleman J, Kovner C . Factors influencing the use of registered nurse overtime in hospitals, 1995-2000. _J Nurs Scholarsh_ 2005; 37 (2): 165–172. Article  Google Scholar  *

Griffiths P, Dall'Ora C, Simon M, Ball J, Lindqvist R, Rafferty AM _et al_. Nurses' shift length and overtime working in 12 European countries: the association with perceived

quality of care and patient safety. _Med Care_ 2014; 52 (11): 975–981. Article  Google Scholar  * Canadian Neonatal Network_Abstarctor's Manual v2.1.2_. Available at

http://www.canadianneonatalnetwork.org/portal/CNNHome/Publications.aspx; 2014. * Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M _et al_. A new and improved population-based

Canadian reference for birth weight for gestational age. _Pediatrics_ 2001; 108 (2): E35. Article  CAS  Google Scholar  * Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and

SNAPPE-II: simplified newborn illness severity and mortality risk scores. _J Pediatr_ 2001; 138 (1): 92–100. Article  CAS  Google Scholar  * Fédération Interprofessionnelle de la Santé du

QuébecConvention collective 2011–2015, article 19.01. Quebec, Canada. * Ministère de la Santé du QuébecCatégorisation des soins neonatals en centres tertiaries. Quebec, Canada; 2012.. *

Gouvernement du QuébecRapport 2014–2015 des incidents et accidents survenus lors de la prestation des soins et services de santé au Québec. Available at http://msss.gouv.qc.ca/. Accessed 29

May, 2017. * Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM . Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. _Pediatrics_

1988; 82 (4): 527–532. CAS  PubMed  Google Scholar  * Papile L, Burstein J, Burstein R, Koffier A . Incidence and evolution of subependymal and intraventricular hemorrhage in pre- mature

infants: a study of infants &lt;1500gms. _J Pediatr_ 1978; 92: 529–534. Article  CAS  Google Scholar  * International Committee for the Classification of Retinopathy of Prematurity. An

international classification of retinopathy of prematurity. _Pediatrics_ 1984; 74 (1):127–133. Google Scholar  * Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L _et al_.

Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. _Ann Surg_ 1978; 187 (1): 1–7. Article  CAS  Google Scholar  * Institute for Digital Education.

Regression diagnostics, Ch. 2. In: _Regression with SPSS_. UCLA: Los Angeles, 2016 Available at http://www.ats.ucla/.edu/stat/spss/webbooks/reg/chapter2/spssreg2.htm. Accessed 12 November,

2016. * Rothman KJ . No adjustments are needed for multiple comparisons. _Epidemiology_ 1990; 1 (1): 43–46. Article  CAS  Google Scholar  * Profit J, Petersen LA, McCormick MC, Escobar GJ,

Coleman-Phox K, Zheng Z _et al_. Patient-to-nurse ratios and outcomes of moderately preterm infants. _Pediatrics_ 2010; 125 (2): 320–326. Article  Google Scholar  * Castrodale V, Rinehart S

. The golden hour: improving the stabilization of the very low birth-weight infant. _Adv Neonatal Care_ 2014; 14 (1): 9–14. Article  Google Scholar  * Bonner KM, Mainous RO . The nursing

care of the infant receiving bubble CPAP therapy. _Adv Neonatal Care_ 2008; 8 (2): 78–95. Article  Google Scholar  * van Zanten HA, Tan RN, van den Hoogen A, Lopriore E, te Pas AB .

Compliance in oxygen saturation targeting in preterm infants: a systematic review. _Eur J Pediatr_ 2015; 174 (12): 1561–1572. Article  CAS  Google Scholar  * Donabedian A . Evaluating the

quality of medical care. _Milbank Mem Fund Q_ 1966; 44 (3 Suppl): 166–206. Article  Google Scholar  * Whitfield M, Chessex P . The need for public involvement when operating a regionalized

neonatal care system at maximum capacity. _Paediatr Child Health_ 2010; 15 (9): 573–575. Article  Google Scholar  Download references ACKNOWLEDGEMENTS We thank the staff of the Canadian

Neonatal Network (CNN) Coordinating Centre, for database support. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Pediatrics, McGill University Health Centre, Montreal, QC,

Canada M Beltempo * Department of Economics, Université Laval, Ville de Québec, QC, Canada G Lacroix * Department of Pediatrics, CHU de Québec and Université Laval, Ville de Québec, QC,

Canada M Cabot & B Piedboeuf * Department of Health Administration, Université de Montreal, Montreal, QC, Canada R Blais Authors * M Beltempo View author publications You can also search

for this author inPubMed Google Scholar * G Lacroix View author publications You can also search for this author inPubMed Google Scholar * M Cabot View author publications You can also

search for this author inPubMed Google Scholar * R Blais View author publications You can also search for this author inPubMed Google Scholar * B Piedboeuf View author publications You can

also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to M Beltempo. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest.

ADDITIONAL INFORMATION Supplementary Information accompanies the paper on the _Journal of Perinatology_ website SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION (DOCX 47 KB) RIGHTS AND

PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Beltempo, M., Lacroix, G., Cabot, M. _et al._ Association of nursing overtime, nurse staffing and unit occupancy

with medical incidents and outcomes of very preterm infants. _J Perinatol_ 38, 175–180 (2018). https://doi.org/10.1038/jp.2017.146 Download citation * Received: 31 January 2017 * Revised: 14

July 2017 * Accepted: 11 August 2017 * Published: 21 September 2017 * Issue Date: February 2018 * DOI: https://doi.org/10.1038/jp.2017.146 SHARE THIS ARTICLE Anyone you share the following

link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature

SharedIt content-sharing initiative