Nursing researchers have shown that nurses' qualifications can have a big impact on inpatient mortality in adults; however, the same relationship had yet to be established in the pediatric population. To help determine whether such a relationship exists, researchers conducted a national survey study analyzing the effects of nursing and procedural characteristics on mortality rates in pediatric cardiac surgery patients.

Nursing administrators from 38 children's hospitals responded to an electronic survey requesting information on nursing-related qualifications such as staffing and education levels; specialty certifications; and years of experience. In addition, unit processes, such as the use of procedural checklists and the collection and reporting of quality metrics, were considered. The participating centers had to meet two criteria for inclusion in the survey: performance of a minimum of 50 cardiac operations over two years and provision of their hospital's data to the Pediatric Health Information System (PHIS), a large clinical database that records patient outcomes, among other clinical and financial information, during 2009 and 2010. The survey responses were linked to each hospital's patient-level data in the PHIS.

A risk-adjusted analysis showed that the likelihood of in-hospital death increased as the percentage of relatively inexperienced pediatric ICU (PICU) nurses (those with two years' experience or less) increased. When the percentage of highly experienced PICU nurses (those with 11 years' experience or more) increased, the likelihood of death decreased. Other factors found to decrease the odds of death were the percentage of nurses with nursing baccalaureates and the ICU's participation in national quality metric benchmarking.

Further analysis revealed a critical cut point in the percentage of PICU nurses a unit needs to turn the mortality tide: when 20% of the PICU nurses had two years' experience or less, the odds of inpatient death increased significantly.

Based on these findings, the authors suggest that nursing administrators seek the right balance of new and experienced nurses, support residency programs for new nurses, and develop efforts to retain experienced nurses in order to obtain the best possible outcomes in pediatric cardiac surgery patients.

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