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27 Sep 2014

Better nursing resources for critically ill babies could improve health of 7 out of 10 Black preemies

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September 27, 2014 Category: Health Posted by:

 In the first study of its kind about critically ill infants, a University of Pennsylvania School of Nursing  investigation shows that an insufficient number of nurses and poor work environments are associated with poorer health of infants born in hospitals that care for disproportionately many black infants. The research was published in the interdisciplinary journal Health Services Research. Lead author Eileen Lake, PhD, RN, is the Associate Director of the Center for Health Outcomes and Policy Research at Penn Nursing.

“This novel study documents that black infants get their care in hospitals that have poorer nursing resources. Fewer infants in these hospitals receive breast milk, which the Surgeon General recommends for all infants. More infants get life-threatening infections. These poorer outcomes impact growth and health over the life course,” Lake says.

Lake’s findings are detailed in her article “Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care.” Her research studied more than 8,000 VLBW infants in 98 Vermont Oxford Network member neonatal intensive care units (NICUs) across the country.  In the nearly 900 NICUs in the U.S., 56,000 VLBW infants are born each year, 30 percent of which are black. In the hospitals that serve disproportionately more black infants, infections were 29 percent more frequent and discharge to home without breast milk was 47 percent more frequent.

Her research showed that hospitals treating the majority of critically-ill black infants have more nurse understaffing and work environments that are less supportive of excellent nursing practice.  These NICU nursing features accounted for a large fraction of health differences across hospitals. The research concluded that improvements in nurse staffing and environments have potential to improve the quality of care for seven out of ten black VLBW infants, who are born in high-black hospitals in the United States.

“Policymakers who are concerned with health disparities in this country should pay attention to these findings and the importance of nursing in the hospitals where these babies are born.  A first step to remedy the inferior nursing resources would be to include nurses in decisions at all levels of the hospital,” Lake says. “Since seven out of 10 black VLBW infants are born in these hospitals, improvements in nursing could reduce disparities in health outcomes for these fragile infants.”

Research reported in this press release was supported by National Institute of Nursing Research (NINR) of the National Institutes of Health under award number R01NR010357. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. NIH communicates this requirement to its grantees in the NIH notice of award, and the NIH Grants Policy Statement (Section 8.2.1). This acknowledgement statement also meets Federal regulations that require grantees to acknowledge Federal funding. This study also received funding from the Robert Wood Johnson Foundation.

The paper can be accessed by using the link below:


Lake leads a program of research on the contributions of the nurse’s work environment and clinical nursing expertise to patient outcomes. She has developed an instrument to measure the work environment that is endorsed by the National Quality Forum as a nursing care performance standard that is used internationally. Lake is a member of Sigma Theta Tau International Nursing Honor Society and a fellow of the American Academy of Nursing.

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