Overstaffing and Understaffing Are Associated With Adverse Events In a Level III Neonatal Intensive Care Unit.

Area of Science:

• Neonatal Intensive Care Unit (NICU) Nursing
• Patient Safety Research
• Healthcare Management

Background:

• Adverse events (AEs) in neonatal intensive care units (NICUs) pose significant risks to vulnerable infants.
• The nurse-to-patient ratio (NPR) is a critical factor influencing patient safety and care quality.
• Understanding the relationship between staffing levels and AEs is essential for optimizing NICU operations.

Purpose of the Study:

• To evaluate the association between the nurse-to-patient ratio (NPR) and the occurrence of adverse events (AEs) in a level III NICU.
• To identify specific staffing conditions (understaffing, overstaffing) associated with increased AEs.
• To explore unit-specific factors contributing to AEs, such as shift overlaps and shift times.

Main Methods:

• Retrospective register study utilizing data from 2020-2022.
• Data sources included patient safety incident reports, nurse scheduling, and hospital information systems.
• Nurse-to-patient ratios (NPR) were categorized (0.33:1, 0.75:1, 1:1, 1.5:1) based on patient care intensity per shift.

Main Results:

• A total of 382 AEs were reported during the study period.
• Most AEs occurred during understaffed (61%) or overstaffed (29.8%) periods.
• AEs were also frequent during shift overlaps (26%) and morning shifts (49%).
• Significant differences in patient distribution were observed during AEs in intensive care (P=0.0013) and high maintenance intensive care (P<0.0001).

Conclusions:

• Both understaffing and overstaffing significantly increase the risk of adverse events in the NICU.
• Achieving an optimal nurse-to-patient ratio is vital for preventing AEs and enhancing patient safety.
• Regular review of AE reports can identify unit-specific risks (e.g., shift overlaps, high-risk shifts) to inform effective staffing and improve care quality.