Author Insights: Better Nursing Leads to Better Outcomes for the Tiniest Babies

Eileen T. Lake, PhD, RN, of the University of Pennsylvania School of Nursing, and her colleagues found that low-birth-weight neonates fare better at hospitals that meet very high standards for nursing care. (Image: Karen Gowen)

Very low-birth-weight neonates fare better at hospitals that have been recognized for nursing excellence, according to an article published in JAMA today.

How well neonates born weighing from 501 to 1500 g survive depends heavily on the care they receive in the neonatal intensive care unit (NICU). Nurses in the NICU play a critical role in providing that care, according to Eileen T. Lake, PhD, RN, the Jessie M. Scott Endowed Term Associate Professor in Nursing and Health Policy at the University of Pennsylvania School of Nursing. She explained that these nurses do complex assessments; implement intensive therapy to promote optimal respiration, feeding, and cardiac function; and monitor their tiny patients for subtle signs of distress.

To assess the effect that very high–quality nursing care has on this fragile subset of patients, Lake and her colleagues compared the outcomes of more than 70 000 very low-birth-weight neonates at 558 hospitals around the country based on whether the hospital had been recognized for nursing excellence by the American Nurses Credentialing Center. The center confers so-called Magnet recognition on health care institutions that undergo a multiyear process to promote nursing leadership, effective communication and teamwork among clinicians, evidence-based practices, and data-driven efforts to boost the quality of care. Dr Lake discussed her team’s findings with news@JAMA.

news@JAMA: How much of an effect did a hospital’s nursing status have on infant outcomes?

Dr Lake: We looked at 3 infant outcomes: severe brain hemorrhage, hospital-associated infection, and death. In Magnet hospitals, mortality during the first week is lower, brain hemorrhage rates are lower, and so is infection. These are all serious complications that happen frequently in this patient population. Overall, we found that 13% of very low-birth-weight infants die during the course of their hospitalization. When looking at Magnet vs non-Magnet hospitals, the percentage of infants who have these poor outcomes is 1% to 2% lower. Each percentage point reduction is about 300 fewer babies who have one of these poor outcomes in this hospital sample.

news@JAMA: How might a hospital’s Magnet status help improve infant survival and reduce complications?

Dr Lake: To get that credential, it’s a several-year process. Hospitals are required to achieve excellent standards across departments in nurse leadership, professional nursing practice, nursing practice based on evidence, and collaboration with other clinicians. The reason a hospital pursues that status is to provide the best-quality nursing care. Hospitals that achieve this status have a commitment to quality care.

news@JAMA: How can you tell whether their Magnet status or some other aspect of clinical care contributed to the improved outcomes?

Dr Lake: In future research, we want to determine what the outcomes were like in hospitals before and after they achieved Magnet status.

news@JAMA: How common is it for hospitals to have earned Magnet recognition?

Dr Lake: Only 7% of hospitals in the United States have this credential. However, 1 in 5 hospitals with a neonatal intensive care unit have achieved this high standard.

news@JAMA: Were there other findings of note?

Dr Lake: The fraction of black infants born in Magnet hospitals was lower than the general population. Black infants were not accessing the hospitals with the best outcomes, even though they have a higher risk of mortality than white infants. Future research may tell us what accounts for that pattern. Part of the explanation for this likely has to do with the fact that many black individuals may not have a Magnet status hospital in their community.

news@JAMA: How would you like mothers, hospitals, and clinicians to use your findings?

Dr Lake: An expecting mother who is at high risk of having a low-birth-weight infant—one having a multiple birth or who has high blood pressure or other risk factors—can find out if her hospital has earned Magnet status. We hope the findings spark discussions among hospital executives about achieving excellence in nursing and begining to advance on the domains of excellence. We hope clinicians discuss how nursing care supports good patient outcomes and support nurses at their institution to work to the full extent of their licenses within health care teams.

Categories: Neonatology and Infant Care, Nursing Care, Quality of Care