2024 Critical Care Congress Skip to main content
2024 Critical Care Congress Main banner
Back
ViewAttendees 1

Association Between Nursing Workforce Turnover and Agency Use on Pediatric Intensive Care Outcomes

Sunday, January 21, 2024
12:15 PM – 12:25 PM MT
Location: Connections Central - Star Research Theater
Introduction: Children’s hospitals are experiencing staffing strain secondary to increased patient volumes coupled with increased turnover of staff, including nurses. Many hospitals have subsequently used temporary agency workers to fill vacant positions. We performed this study to test whether the proportion of nursing (RN) turnover or agency staffing in pediatric intensive care units (PICUs) is associated with mortality or complications.


Methods: This IRB-exempt, retrospective cohort study linked data from the Pediatric Health Information Systems (PHIS) and PROSPECT Hospital Essentials (PROSPECT) databases from January 2019 to December 2022. Demographics, a severity of illness index, and outcomes of mortality and medical/surgical complications were extracted for all PICU admissions from PHIS to hospitals represented in both databases. The proportion of annual PICU agency staffing and PICU nurse turnover were extracted from PROSPECT. Data were analyzed by year with negative binomial regression with log-transformed offset terms for admissions (mortality model) and patient days (medical/surgical complications models) using R.


Results: We included 222,194 admissions to PICUs from 21 hospitals. We did not observe an association between mortality or surgical complications and either agency staffing or RN turnover. Increased proportion of agency staffing and RN turnover were significantly associated with medical complications in 2021 and 2022 but not 2019 or 2020. These associations were significant after adjusting for illness severity (all P< 0.01), such that a PICU with 10% agency staff per year was predicted to have 110 and 35 more medical complications in 2021 and 2022, respectively, compared to a unit with no agency staff. A PICU with 10% greater-than-average RN turnover was predicted to have 18 and 33 more medical complications in 2021 and 2022, respectively, compared to a PICU with average RN turnover for each year.


Conclusions: In this multicenter study of United States children’s hospitals, medical complications among children with critical illness were significantly associated with the proportion of PICU agency staff and RN turnover in the years 2021 and 2022. More work is needed, including evaluating RN workload and PICU census, to better understand this relationship and guide RN staffing policies.