The organization of critical care nursing and outcomes of mechanically ventilated older adults

Outcomes for mechanically ventilated older adults vary widely but it is not well understood what accounts for these variations. Lacking, however, is a comprehensive understanding of how critical care nursing, the largest intensive care unit (ICU) provider, affects patient outcomes. This study was a multi-state secondary analysis that examined the organization of critical care nursing and outcomes of 56,826 mechanically ventilated ICU admitted older adults cared for in 303 hospitals. Critical care nurse staffing, the practice environment, hospital level proportion of bachelor\u27s prepared (BSN) nurses and proportion of specialty certified nurses were the critical care nursing measures. Outcomes were 30-day mortality, ICU and hospital length of stay, ventilator associated pneumonia and central line associated bloodstream infection. Nurse survey data (from 3200 critical care nurses) were merged with Medicare claims and hospital administrative data. Logistic and negative binomial regression modeling using robust standard errors were employed to jointly assess the organization of critical care nursing on outcomes, controlling for hospital and patient characteristics. Better ICU practice environments were associated with 10% lower odds of death but in hospitals with a better practice environment and better ICU staffing, patients experienced 13% lower odds of death. A 10% increase in the hospital proportion of BSN critical care nurses was associated with 2% lower odds of death. Patients were less likely to develop healthcare associated infections when cared for in hospitals with higher ratings of ICU staffing and resource adequacy. Further examination is warranted to determine causal relationships. This is the first evidence of a significant association between more BSN-prepared nurses and better ICU practice environment on reduced odds of death in mechanically ventilated older adults. The critical care practice environment also yielded optimal outcomes when ICU staffing was also better. Health care associated infections were less likely to occur when staffing and resources in the critical care environment were better. Improvements in nurse staffing, practice environment and in critical care nurse education may hold promise for improving outcomes of ICU patients