Pediatric Cardiovascular Critical Care in the United States: Nursing and Organizational Characteristics

Abstract

Nursing and organizational characteristics influence patients' outcomes. Little is known about nursing structure and process supports in the intensive care units of children's hospitals. Objectives To describe and understand nursing and organizational characteristics of cardiovascular care in children's hospitals. Descriptive analyses were used to identify and describe nursing and unit characteristics of 43 children's hospitals. An electronic survey instrument was designed to elicit data from nurse leaders. Nursing and unit parameters varied significantly. Most registered nurses (70%) had baccalaureate degrees and worked full time. Every intensive care unit had nurses with specialty certification. A total of 51% of nurses had 5 or fewer years of clinical experience. Indirect resources also varied. Unit secretaries were employed by 98% of units, and 100% had a nurse manager and/or a director plus an attending physician. A total of 77% of the units had advanced practice nurses. Processes of care included checklists in 100% of the units, standardized communication in 95%, quality metrics in 91%, and nurse-developed algorithms in 44%. Among the units, 56% had Magnet recognition, and 3 were recipients of a Beacon Award. Cardiovascular intensive care varies widely across children's hospitals. Opportunities exist for support and retention of an intergenerational nursing workforce. These findings may serve as a contemporary benchmarking source and foundation to standardize models of care, support, and resource utilization in pediatric intensive care units.