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Nursing workload by dependency category of baby in a tertiary neonatal intensive care setting

Presented at the Neonatal Society 2002 Summer Meeting (programme).

Milligan DWA, Wooler L, Ward Platt MP, Gibbs A, Mackley B, Carruthers P

Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle Upon Tyne, UK

Introduction: There is only one published study which has assessed the time spent by neonatal nurses caring for babies with a range of conditions. Since then both case mix and clinical practice have changed. This study examined neonatal nursing dependency in the context of current practice.

Aims: For each system of categorising care: to re-examine that of the Northern Region, to validate that of the British Association for Perinatal Medicine as recently revised, and to evaluate the Nottingham scoring system proposed by Gibbs.

Methods: We performed activity sampling analysis of nursing activity by trained observers at 10 minute intervals for three 12 hours day shifts and one 12 hour night shift. We coded work using a taxonomy of nursing activities. The grades of nurse and the dimensions making up each of the category systems were recorded.

Results: Between 27 and 30 babies were observed on each shift. Sufficient nursing capacity was available to allow all babies to receive the care they needed. No babies scored at the highest level of the Nottingham system. Babies receiving 'normal' baby care took similar amounts of nursing time to those receiving 'special care', and are counted together in the analysis below. Units are minutes/baby/hour.

Conclusions: A three category scale provided an adequate functional description of neonatal unit workload. Babies on nasal continuous positive airways pressure support (nCPAP) required nursing time equivalent to the BAPM high dependency category or Northern Region category B, but babies at the highest level of intensive care occupied the full attention of a single nurse. Fully orally fed babies needed similar nursing input to those in low dependency (special) care.

Arch Dis Child 1993;68:534-38
Arch Dis Child 1993;68:539-43

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