Nursing Care Disparities in Neonatal Intensive Care Units

Health Serv Res. 2018 Aug;53 Suppl 1(Suppl Suppl 1):3007-3026. doi: 10.1111/1475-6773.12762. Epub 2017 Sep 14.


Objectives: To describe the variation across neonatal intensive care units (NICUs) in missed nursing care in disproportionately black and non-black-serving hospitals. To analyze the nursing factors associated with missing nursing care.

Data sources/study setting: Survey of random samples of licensed nurses in four large U.S. states.

Study design: This was a retrospective, secondary analysis of 1,037 staff nurses in 134 NICUs classified into three groups based on their percent of infants of black race. Measures included the average patient load, individual nurses' patient loads, professional nursing characteristics, nurse work environment, and nursing care missed on the last shift.

Data collection: Survey data from a Multi-State Nursing Care and Patient Safety Study were analyzed (39 percent response rate).

Principal findings: The patient-to-nurse ratio was significantly higher in high-black hospitals. Nurses in high-black NICUs missed nearly 50 percent more nursing care than in low-black NICUs. Lower nurse staffing (an additional patient per nurse) significantly increased the odds of missed care, while better practice environments decreased the odds.

Conclusions: Nurses in high-black NICUs face inadequate staffing. They are more likely to miss required nursing care. Improving staffing and workloads may improve the quality of care for the infants born in high-black hospitals.

Keywords: Missed nursing care; health disparities; nurse staffing; nurse work environment; very low birthweight infants.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Cross-Sectional Studies
  • Environment
  • Healthcare Disparities / standards
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal / standards
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / statistics & numerical data*
  • Personnel Staffing and Scheduling / statistics & numerical data*
  • Quality of Health Care
  • Retrospective Studies
  • United States
  • Workload / statistics & numerical data