Patients in ICUs contract fewer infections when there is adequate RN staffing and where RNs report satisfactory working conditions. But when ICUs are understaffed or RNs work many overtime hours, patients acquire more infections and skin ulcers, according to research led by Patricia W. Stone of the Columbia University School of Nursing in New York City.

Stone's team analyzed data on 15,846 elderly Medicare patients in 51 adult ICUs at 31 hospitals that used the National Nosocomial Infections Surveillance system from the Centers for Disease Control and Prevention. They then surveyed 1,095 RNs from the ICUs on working conditions and the organizational climate. The researchers also obtained information on staffing levels, overtime, and wages from payroll departments and looked at hospital profitability and Magnet status.

In ICUs with higher RN staffing, patients had lower rates of central line-associated bloodstream infections, ventilator-associated pneumonia, and skin ulcers. Patients in ICUs with better staffing levels were also less likely to die within 30 days. As RNs worked more overtime hours, the rates of catheter-associated urinary tract infections and skin ulcers increased. RN wages, Magnet accreditation, and hospital profitability were not associated with the infection rate.

RNs provide nearly 100% of the care in ICUs, which are often inadequately staffed. One solution the authors suggest is to cross-train qualified nurses in ICU skills to alleviate staff shortages and reduce overtime hours. But before volunteering to work overtime and extra shifts, Stone cautions, staff nurses should consider the mounting evidence showing that nurses working long hours can diminish patient safety. No nurse should go to work when ill, and family and personal emergencies certainly warrant time off. Nonetheless, Stone says, "nurses should understand the burden unplanned absenteeism puts on the other staff and the safety of the patients."

Carol Potera