Observational studyJAMA network open2025
Pediatric Intensive Care Nurse Staffing Measures and Patient Outcomes During the COVID-19 Pandemic.
Observational study in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Knowledge, attitude, and practice of central line-associated bloodstream infection prevention among intensive care unit nurses in Hebei Province, China: a cross-sectional study.Frontiers in public health · 2026Article
- Error in the Byline.JAMA network open · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
14 authors.
Funding
Abstract
Importance: During the COVID-19 pandemic, pediatric intensive care units (PICUs) reportedly relied more on temporary contract nurses hired through staffing agencies (agency nurses) to fill gaps related to increased nurse turnover. It is unknown whether these changes in nurse staffing were associated with patient outcomes. Objective: To determine whether the proportion of PICU agency staff or nurse turnover was associated with patient outcomes during the pandemic. Design, Setting, and Participants: This retrospective, multicenter, linked database cross-sectional study was performed at PICUs in the US between January 1, 2019, and December 31, 2022. Participants included patients younger than 19 years admitted to a PICU with data in both the Children's Hospital Association Pediatric Health Information Systems and PROSPECT Hospital Essentials databases. Data were analyzed from March 15, 2023, to August 1, 2024. Exposure: The yearly proportion of agency nurses and nurse turnover. Main Outcomes and Measures: Descriptive characteristics were examined for PICUs grouped by the median proportion of agency nurses or nursing turnover each year. A variable staffing metric was defined as greater than 10% change in the proportion of agency nurses from the intrahospital baseline in 2019. Multivariable negative binomial models controlling for illness severity and hospital effect with median yearly staffing metrics examined whether the proportion of agency nurses or nurse turnover was associated with mortality, PICU complications, central line-associated bloodstream infections, or ventilator-associated pneumonias. Results: There were 218 789 admissions across 20 PICUs, with a median patient age of 45 (IQR, 9-138) months (119 997 [54.8%] male). PICUs with a variable proportion of agency nurses had significantly more patients with PICU complications (9695 of 120 017 [8.1%] vs 7141 of 98 772 [7.2%]; P < .001). Multivariable analysis indicated an increase of 19 (95% CI, 7-39) ventilator-associated pneumonias per 10 000 ventilator-days in 2020. For a PICU with 10% higher nurse turnover than the median turnover, there were 10 (95% CI, 8-13) more PICU complications per 10 000 patient-days in 2022. Conclusions and Relevance: In this cross-sectional study of nurse staffing measures and patient outcomes during COVID-19, complex associations existed throughout the study years. More data are needed to determine optimal staffing strategies during times of workforce strain.
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