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RN education, experience linked to peds cardiac surgery outcomes

Saturday November 16, 2013
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Nursing education and experience are associated with outcomes for pediatric patients undergoing cardiac surgery, according to a study.

Nursing leaders from 38 hospitals, led by Patricia Hickey, RN, PhD, MBA, FAAN, vice president of critical care and cardiovascular services at Boston Children’s Hospital, conducted the research and found that nurse education preparation at the baccalaureate level or higher also improved mortality rates in these hospitals.

The study, published in the December issue of the Journal of Nursing Administration, examined outcomes for 20,407 pediatric cardiac surgery patients. In pediatrics, congenital heart disease is the most commonly occurring birth defect requiring surgical intervention for survival, according to information in the study. These patients also consume a disproportionate share of hospital resources within the U.S. healthcare system because of their critical care requirements.

Among the national sample of 3,413 pediatric critical care nurses, 71% held a baccalaureate degree or higher in nursing and 52% had five years or fewer of nursing experience.

Years of nursing experience was significantly associated with improved patient outcomes and independently associated with in-hospital mortality. In these pediatric critical care units, a cut point of 20% appears to be the critical value at which the percentage of RNs with two years of clinical experience or less significantly increases the odds of death, according to the study authors. The odds of in-hospital mortality increases again when more than 25% of nurses have two years of experience or less.

Importantly, years of ICU experience alone was not a predictor of mortality, but total clinical experience was a significant factor. “This finding may reinforce the notion that experiential knowledge and skill acquisition is cumulative over time regardless of the clinical setting, as professional nurses advance their practice,” the authors wrote.

Nursing education at the baccalaureate level or higher also was associated with decreased odds of death for children undergoing cardiac surgery, the authors reported. The odds of death also decreased as the institutional percentage of critical care nurses with 11 or more years clinical experience increased and again as the percentage with more than 16 years of clinical experience increased. Mortality odds also decreased for hospitals participating in national quality metric benchmarking.

Based on their findings, the study authors recommended that pediatric ICUs should not have more than 20% of their staff with less than two years’ experience.

In a news release, Hickey noted two key conclusions of the findings: “Ongoing attention to the proportional mix of RN experience levels in pediatric units is necessary; and there is a continued need for retention strategies to ensure that experienced nurses remain in the pediatric critical care environment. Our findings support the [Institute of Medicine] recommendations for nurse residency programs to support new graduate nurses.”

“While prior studies have associated greater proportions of nurses educated at the baccalaureate level or higher with lower mortality and failure-to-rescue rates, Dr. Hickey and colleagues have specifically advanced the science of pediatric nursing practice to affirm the importance of RN experience levels and education preparation in the safe and effective care of children,” Laura Wood, RN, DNP, MS, senior vice president and CNO at Boston Children’s, said in the news release. “This work will inform our ongoing efforts to improve care for our patients.”

Study abstract: http://journals.lww.com/jonajournal/Abstract/2013/12000/The_Effect_of_Critical_Care_Nursing_and.6.aspx


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