Increased nurse-to-nurse familiarity linked to better ICU patient outcomes
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Key takeaways:
- Fewer deaths took place during ICU shifts staffed by nurses who had more previously shared shifts between them.
- Suboptimal nurse staffing negatively impacted the risk for ICU patient mortality.
Nurses working in the ICU had a lower risk for experiencing a patient death during their shift if nurse-to-nurse familiarity at that time was high, according to results published in American Journal of Respiratory and Critical Care Medicine.
Low nurse-to-nurse familiarity and suboptimal nurse staffing during a shift heightened this risk, according to researchers.
“These findings remained consistent during the first 12 hours of patient admission and suggest that nurse familiarity and nurse staffing have important implications for patient outcomes each shift,” Antoine Duclos, MD, PhD, professor of public health and director of research on health care performance at Université Claude Bernard Lyon, and colleagues wrote.
In a multicenter, retrospective observational study of eight ICUs, Duclos and colleagues assessed how nurse-to-nurse familiarity impacts the risk for death from January 2011 to December 2016 across a collective 35,072 shifts.
By evaluating the average number of past day or night shifts shared between each nursing team member, researchers calculated the level of daily nurse-to-nurse familiarity, with a number less than 50 signaling suboptimal familiarity.
Researchers determined what factors impacted mortality per shift by using a multiple modified Poisson regression model that adjusted for several confounders: ICU, patient characteristics, patient-to-nurse ratio (suboptimal, > 2.5), patient-to-assistant nurse ratio (suboptimal, > 4), nurse experience length and workload.
Across the eight ICUs, admissions totaled 43,479 patients (65% men), and 3,311 of these patients died during their stay.
In terms of nurse-to-nurse familiarity, the average number of shifts in which members of the nursing team collaborated with each other was 53.
About half of shifts (51%) had low nurse-to-nurse familiarity, although this declined when evaluating two consecutive shifts (28%) and three consecutive shifts (21%).
With higher nurse-to-nurse familiarity, researchers observed a decreased relative risk for patient death (RR = 0.9 per 10 shifts; 95% CI, 0.82-0.98) during that shift following confounder adjustment.
Notably, when the patient-to-nurse ratio was suboptimal, researchers observed a significantly elevated risk for patient mortality during that shift (RR = 1.35; 95% CI, 1.02-1.77).
Researchers further found a heightened mortality risk during an ICU shift when three factors came together: reduced nurse-to-nurse familiarity over three consecutive shifts, suboptimal patient-to-nurse ratio and suboptimal patient-to-nurse assistant ratio (RR = 2.4; 95% CI, 1.43-4.03).
As the number of shifts shared between the nurses grew, patient death during a shift declined (14% following 0 collaborations vs. 5% following 100 collaborations vs. 2% following 200 collaborations).
Lastly, researchers found that nurses working in the ICU had a heightened risk of experiencing a death of a patient who was admitted fewer than 12 hours ago during a shift when nurse-to-nurse familiarity was low and patient-to-nurse and patient-to-assistant nurse ratios were both suboptimal (RR = 4.69; 95% CI, 2.42-9.09).
“Confirmation of present results in other health care systems is needed,” Duclos and colleagues wrote. “Unanswered questions are the role of affinity in the nursing team members and the impact of a self- as compared with a directed-nurse schedule.”
This study by Duclos and colleagues demonstrates how significant interactions between nurses are when evaluating patient outcomes and prompts action for studies that look deeper into nurse familiarity, according to an accompanying editorial by Hannah C. Ratliff, BS, BSN, RN, of the University of Michigan School of Nursing, and colleagues.
“We recommend that future research should examine familiarity among nurses and its impact on patient outcomes at the individual nurse–patient level,” Ratliff and colleagues wrote. “This work should include an examination of actual interactions among individual nurses or other measurements of familiarity to assess familiarity more precisely. Such detailed measurement will inform how to improve or modify familiarity among nursing staff, while taking into consideration autonomy over nurses’ work schedules.”