How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care

Research Objective[SH1] :Parental presence in the neonatal intensive care unit (NICU) is essential for families, especially mothers, to be partners and active participants in the care of their infants. Parental presence in the NICU is particularly important to achieve a smooth transition from hospital to home. However, NICUs vary in their policies on parent visitation and inclusion of parents in decisions about and care of their infant. Nurses are the principal caregivers in the NICU setting. The nurse work environment may influence whether parents spend time with their hospitalized infants. Features of work environments, such as a competent and supportive nurse manager, adequate staffing and resources, collegial relationships between physicians and nurses, nurse voice in hospitals matters, and a recognized nursing philosophy as the foundation for nursing care, may influence the extent to which parents find it easy and comfortable to spend time in the NICU. We utilized a national dataset to examine the relationship between the nurse work environment and the presence of parents in the NICU.

Study Design:We conducted a cross-sectional correlational study utilizing nurse survey data including the National Quality Forum-endorsed Practice Environment Scale of the Nursing Work Index (PES-NWI), which measures the work environment across five domains noted above as well as a composite measure. Nurses indicated if parents of the infants they cared for were present for at least half of the last shift worked. Pearson correlation and bivariate regression were used to test for associations between the work environment and parental presence.

Population Studied:U.S. NICUs. This national sample comprised 104 NICUs, in which 6060 nurses reported on the characteristics of their unit and about 15,233 infants they cared for on the last shift they worked.

Principal Findings: On average, the parents of 60% of infants were present during the shift. This ranged across the NICU sample from 32% to 79% (SD = 9.7%). The PES-NWI composite score as well as two subscales, Nurse Participation in Hospital Affairs and Manager Leadership and Support, were significant predictors of parental presence in bivariate regression models. A 1SD higher score in the composite or either subscale was associated with a 0.25 SD increase in parental presence in the NICU, equivalent to 2.5 percentage points.

Conclusion:Parental presence in the NICU is significantly associated with better nurse work environments, particularly where nurses are well supported through managerial leadership and where nurses have the ability to participate in hospital affairs.

Implications for Policy or Practice:These data suggest supporting professional nursing and strong nurse leadership are essential to the creation of a patient centered culture in the NICU that encourages and facilitates parental presence.

Funding: Small Grant Award 2014 -Sigma Theta Tau International- Honor Society of Nursing