Patricia A Hickey1, Sara K Pasquali2, J William Gaynor3, Xia He4, Kevin D Hill4, Jean A Connor5, Kimberlee Gauvreau6, Marshall L Jacobs7, Jeffrey P Jacobs8, Jennifer C Hirsch-Romano9. 1. Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, Massachusetts. Electronic address: patricia.hickey@childrens.harvard.edu. 2. Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan. 3. Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Duke Clinical Research Institute, Durham, North Carolina. 5. Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, Massachusetts. 6. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. 7. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 8. Johns Hopkins Children's Heart Surgery, All Children's Hospital, St. Petersburg, Florida. 9. Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Abstract
BACKGROUND: Previous studies have demonstrated the effect of adult nursing skill mix, staffing ratios, and level of education on patient deaths, complication rates, and failure to rescue (FTR). To date, only one known study had examined the effect of nursing experience and education on postoperative pediatric cardiac operations. METHODS: Nursing survey data were linked to The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database for patients undergoing cardiac operations (2010 to 2011). Logistic regression models were used to estimate associations of nursing education and years of clinical experience with in-hospital mortality rates, complication rates, and FTR. Generalized estimating equations and robust standard error estimates were used to account for within-center correlation of outcomes. RESULTS: Among 15,463 patients (29 hospitals), the in-hospital mortality rate was 2.8%, postoperative complications occurred in 42.4%, and the FTR rate was 6.4%. After covariate adjustment, pediatric critical care units with a higher proportion of nurses with a Bachelor of Science degree or higher had lower odds of complication (odds ratio for 10% increase, 0.85; 95% confidence interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of nurses with more than 2 years of experience had lower mortality rates (odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99; p = 0.025). CONCLUSIONS: This is the first study to demonstrate that higher levels of nursing education and experience are significantly associated with fewer complications after pediatric cardiac operations and aligns with our previous findings on their association with reduced deaths. These results provide data for pediatric hospital leaders and reinforce the importance of organization-wide mentoring strategies for new nurses and retention strategies for experienced nurses.
BACKGROUND: Previous studies have demonstrated the effect of adult nursing skill mix, staffing ratios, and level of education on patient deaths, complication rates, and failure to rescue (FTR). To date, only one known study had examined the effect of nursing experience and education on postoperative pediatric cardiac operations. METHODS: Nursing survey data were linked to The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database for patients undergoing cardiac operations (2010 to 2011). Logistic regression models were used to estimate associations of nursing education and years of clinical experience with in-hospital mortality rates, complication rates, and FTR. Generalized estimating equations and robust standard error estimates were used to account for within-center correlation of outcomes. RESULTS: Among 15,463 patients (29 hospitals), the in-hospital mortality rate was 2.8%, postoperative complications occurred in 42.4%, and the FTR rate was 6.4%. After covariate adjustment, pediatric critical care units with a higher proportion of nurses with a Bachelor of Science degree or higher had lower odds of complication (odds ratio for 10% increase, 0.85; 95% confidence interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of nurses with more than 2 years of experience had lower mortality rates (odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99; p = 0.025). CONCLUSIONS: This is the first study to demonstrate that higher levels of nursing education and experience are significantly associated with fewer complications after pediatric cardiac operations and aligns with our previous findings on their association with reduced deaths. These results provide data for pediatric hospital leaders and reinforce the importance of organization-wide mentoring strategies for new nurses and retention strategies for experienced nurses.
Authors: Khalid A Aljohani; Majed S Alamri; Reem Al-Dossary; Hamdan Albaqawi; Khaled Al Hosis; Mohammed S Aljohani; Noura Almadani; Bader Alrasheadi; Rawaih Falatah; Joseph Almazan; Jalal Alharbi Journal: Int J Environ Res Public Health Date: 2022-04-01 Impact factor: 3.390