Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine's conservation model of nursing

mefford l.c. & alligood m.r. (2011) Journal of Nursing Management19, 998–1011 Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine’s conservation model of nursing Aims To explore the influences of intensity of nursing care and consistency of nursing caregivers on health and economic outcomes using Levine’s Conservation Model of Nursing as the guiding theoretical framework. Background Professional nursing practice models are increasingly being used although limited research is available regarding their efficacy. Method A structural equation modelling approach tested the influence of intensity of nursing care (direct care by professional nurses and patient–nurse ratio) and consistency of nursing caregivers on morbidity and resource utilization in a neonatal intensive care unit (NICU) setting using primary nursing. Results Consistency of nursing caregivers served as a powerful mediator of length of stay and the duration of mechanical ventilation, supplemental oxygen therapy and parenteral nutrition. Analysis of nursing intensity indicators revealed that a mix of professional nurses and assistive personnel was effective. Conclusions Providing consistency of nursing caregivers may significantly improve both health and economic outcomes. New evidence was found to support the efficacy of the primary nursing model in the NICU. Implications for nursing management Designing nursing care delivery systems in acute inpatient settings with an emphasis on consistency of nursing caregivers could improve health outcomes, increase organizational effectiveness, and enhance satisfaction of nursing staff, patients, and families.