How Does Understaffing Affect NICU Care?

Every year, approximately 1 in 10 babies born in the United States spend time in a neonatal intensive care unit (NICU). While there are many reasons why a baby may need the specialized care that a NICU can provide, the quality of that care depends on the number and skill level of the nurses and doctors who work there.

Why Are Babies Admitted To The NICU?

Infants spend time in the NICU for a variety of reasons. Most NICU babies are admitted immediately after birth due to either prematurity or low birth weight. These newborns often have difficulty breathing and eating on their own, struggle to regulate their body temperature, may be unable to maintain a steady blood sugar level, and are at risk of developing bleeding in the brain or infections that can quickly become deadly if healthcare providers don’t monitor them closely and intervene quickly. Babies are also commonly admitted if they experienced a traumatic birth that resulted in some sort of injury, heart problems, severe jaundice, infections, or to recover after surgery.

What Does Appropriate Staffing Look Like In A NICU?

Recently, the University of Pennsylvania School of Nursing surveyed nurses across the state and found that nurse-to-patient ratios vary widely at different hospitals. Across the state, the average hospital nurse cares for 5.6 patients at a time. However, they discovered that different hospitals have different staffing ratio averages, ranging from 3.25 to as many as 11 patients per nurse. Unsurprisingly, they also discovered that higher workloads led to worse outcomes. With the data they collected, they were able to conservatively estimate that 1,162 deaths could be prevented if hospitals assigned a recommended maximum of 4 patients to each nurse.

Unfortunately, there’s not a “one-size-fits-all” approach to determining appropriate staffing in the NICU. The National Association of Neonatal Nurses recommends that staffing decisions in the NICU be based on the level of care needed by each infant rather than sticking to any recommended nurse-to-patient ratio, as many of these fragile babies require substantially more care than the average adult patient. Nurses caring for low-risk babies may be able to safely care for 3 or 4 at a time, but a medically complex micro-preemie may need 1 or 2 nurses focused on them exclusively.

When determining appropriate staffing levels in the NICU, it’s important to also consider the nurses' skillset, experience, and competencies on staff. Staffing decisions should also consider family care, teaching, and support. In particular, instruction, support, and encouragement from skilled nursing staff and/or lactation consultants are essential for lactating mothers with babies in the NICU, as breast milk has been associated with a significantly lower risk of developing a serious intestinal disease called necrotizing enterocolitis.

What Are The Risks When A NICU Is Understaffed?

Because critically ill babies are a high-risk population that requires continuous specialized care, the consequences of sub-par care can be substantial. For these fragile infants, many of whom have underdeveloped organ systems, seemingly minor adverse events have the potential to cause major long-term consequences, including death and lifelong disability.

A study published in JAMA Pediatrics found that bloodstream infections are closely associated with understaffing and are even more likely when pooled or temporary nurses work in the NICU. While these nurses may help to improve staffing numbers on paper, they often do not have the skillset or experience needed to properly care for premature or medically frail infants.

Pennsylvania does not have any laws that mandate a specific nurse-to-patient ratio, but many hospitals have their own ratio policies that they strive to maintain. But the bottom line is that minimum staffing ratios are minimums. Hospital administrators need to keep in mind that minimal staffing ratios and optimal staffing ratios are different and should strive to always keep their NICUs operating with however many skilled NICU nurses they need to ensure that every baby gets the opportunity to live a happy, healthy life.

Why Choose Ross Feller Casey?

If your baby was cared for in an understaffed NICU and suffered the consequences of substandard care, you may be entitled to compensation. Inadequate monitoring, slow response time, a lack of breastfeeding support for lactating mothers, and medication errors all become more common as a nurse’s workload grows, and all have the potential to increase the risk of catastrophic injury or death for these vulnerable infants.

If your baby was a victim of an understaffed NICU, the team at Ross Feller Casey is ready to help. Our lawyers have built an unmatched reputation of success when it comes to medical malpractice cases, including those involving critically ill or premature infants. Our on-staff team of Ivy League-trained doctors understands that babies requiring specialized NICU care face a high risk of severe complications if they do not receive the necessary treatment.

When hospital administrators are at fault for providing insufficient staffing, they deserve to be held accountable for any harm that comes to babies who suffer as a result of their negligence.

We handle all our cases on a contingency basis. That means that you will never be asked to pay a thing until a monetary recovery is made in your case. Contact us today for a free consultation.