| Primary Author: | Sharon Barton, PhD, RN, PCNS-BC |
| Co-Principal Investigators/Collaborators: | Linda Aiken, PhD, Jeannie Cimiotti, DNSc, RN, Kathleen Gorman, MSN, RN, NEA-BC, Douglas Sloane, PhD |
| Organization | The Children’s Hospital of Philadelphia, University of Pennsylvania School of Nursing |
Abstract
Purpose
The purpose of this study was to compare nurse reports on availability of nursing resources and quality of care provided to children in general acute care hospitals and children’s hospitals
Background
Few reports address the quality of health care delivered to children despite the estimated 1.8 million who are admitted to hospitals annually. Hospitalized children are vulnerable to medical errors and preventable adverse outcomes; yet, little evidence is available on outcomes in acute care facilities that specialize in the care of children.
Materials & Methods
Survey data from 2006 were available from 3,819 pediatric nurses working in 498 acute care hospitals in four states (CA, FL, NJ, PA). Hospitals were classified as: 1) general acute care hospital with a pediatric unit, 2) a children’s hospital within a larger acute care hospital, and 3) freestanding children’s hospitals. Staffing and resource adequacy was assessed using the Practice Environment Scale of the Nursing Work Index. Logistic regression models were used to estimate the effect of staffing and resource adequacy on outcomes.
Results
Nurses working in freestanding children’s hospitals reported caring for fewer patients and a larger percent were baccalaureate prepared. In a children’s hospital within a hospital there was a significant increase in the odds of nurses reporting not enough staff to get the work done, inadequate support services, and not enough time to discuss patient problems by 43%, 47% (36% in general hospital) and 49%, respectively. In a multivariate model estimating differences between hospital types, high staffing and resource adequacy was significantly associated with a 58% decrease in the odds of surveillance left undone and 56% decrease in the odds of missed changes in patients conditions.
Conclusion
Our findings suggest that there may be differences in nursing resources and outcomes between freestanding children’s hospitals, children’s hospitals within larger institutions, and pediatric units within general hospitals, and that differences in the adequacy of resources may be largely responsible for differences in outcomes.
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