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Characteristics of the NICU Work Environment Associated With Breastfeeding Support

Hallowell, Sunny G. PhD, PPCNP-BC, IBCLC; Spatz, Diane L. PhD, RNC, FAAN; Hanlon, Alexandra L. PhD; Rogowski, Jeannette A. PhD; Lake, Eileen T. PhD, RN, FAAN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000102
Original Research
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PURPOSE: The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support.

SUBJECTS AND DESIGN: This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative.

METHODS: Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds.

RESULTS: The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was associated with a 2% increase in infants provided breastfeeding support. A 1 SD higher score on the Staffing and Resource Adequacy PES-NWI subscale was associated with a 2% increase in infants provided breastfeeding support. There was no association between other NICU nursing characteristics or LCs and nurse-provided breastfeeding support.

CONCLUSIONS: Nurses provide breastfeeding support around the clock. On a typical shift, about 1 in 7 NICU infants receives breastfeeding support from a nurse. Lactation consultants are not routinely available in NICUs, and their presence does not influence whether nurses provide breastfeeding support. Better nurse staffing fosters nurse provision of breastfeeding support.

Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Hallowell); University of Pennsylvania School of Nursing, Philadelphia, and Lactation Program, Children's Hospital of Philadelphia, Pennsylvania (Dr Spatz); University of Pennsylvania School of Nursing, Philadelphia (Dr Hanlon); Rutgers School of Public Health, State University of New Jersey, New Brunswick, and Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Rogowski); and Nursing and Health Policy and Sociology, Center of Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Lake).

Correspondence: Sunny G. Hallowell, PhD, PPCNP-BC, IBCLC, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 10104 (hallowellnp@gmail.com).

This study was supported by the University of Pennsylvania School of Nursing, Office of Nursing Research, 2012 Student Research Pilot Grant, Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative grant “Acuity-Adjusted Staffing, Nurse Practice Environments and NICU Outcomes” (Dr Lake).

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number T32NR007104 “Advanced Training in Nursing Outcomes Research” (Aiken, PI).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors declare no conflict of interest.

© 2014 by The National Association of Neonatal Nurses