Study compares missed nursing care in NICUs for high and low fractions of black infants

Everybody wants a healthy life for their baby. Black babies are more likely to be born prematurely, which puts them at risk for death and developmental problems. In fact, a third of all infant deaths are preterm-related. The critical period in preterm babies' lives is when they are just born and are in the neonatal intensive care unit (NICU). The care they receive is vital to a healthy future.

NICU nurses are quite important because the babies are completely dependent, not fully developed, and require intensive treatments and monitoring. NICU nurses also teach and guide the parents of NICU infants, which is essential so the parents can care for the vulnerable babies when they go home.

Until now, we have not known whether nurses are able to complete all the care that is required for these complex infants. It is generally expected that a neonatal critical care unit is adequately staffed and that all required care is provided. Is it possible that nursing care is missed routinely in some NICUs?

A new study from University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research (CHOPR) compared missed nursing care in NICUs caring for high and low fractions of black infants. Indeed, nurses in hospitals with one-third or more percent black infants missed 50% more nursing care than those in hospitals with less than one-tenth percent black infants. Additionally, nurses cared for a significantly higher number of babies in the hospitals with a high-black infant population. The predominant types of care missed, such as teaching and counseling parents, and preparation for discharge, address parents' capabilities and readiness for infant care at home. The study is set for publication in an upcoming issue of Health Services Research, but is available now online first here.

"If I was a mom and my baby was being cared for in a NICU, I would be really worried about care being missed, as any parent would be. It is very distressing that black moms have more to worry about at an already stressful time." says lead-author Eileen T. Lake, PhD, RN, FAAN, the Jessie M. Scott Endowed Term Chair in Nursing and Health Policy, and CHOPR Associate Director.

The research team used survey data from more than 1,000 staff nurses in 134 NICUs in California, Florida, New Jersey, and Pennsylvania. Missed nursing care is a unique measure that reveals the clinical care process. Missed care is defined as required nursing care that is omitted or delayed in response to multiple demands or inadequate resources.

"Missed nursing care could affect the survival, growth, and development of these infants. Because we know that outcomes are so dependent on care processes," said Lake. "In hospitals where most black infants are born, inferior care from the point of birth could have lifetime consequences. Thus inadequate staffing levels and substandard work environments set nurses up for missing care. Hospitals need to fix their staffing levels and improve their environments so that nurses can do their jobs as they are dedicated to."

This study underscores the need for more supportive care environments in high-black NICUs to assure adequate staffing and that individual nurses are not overloaded.