• Patricia A Hickey, Kimberlee Gauvreau, Courtney Porter, and Jean A Connor.
• Cardiovascular and Critical Care Patient Services, Boston Children's Hospital, Boston, MA.
• Pediatr Crit Care Me. 2018 Aug 1; 19 (8): 718-724.

ObjectivesTo examine the relationship of nursing and unit characteristics including Critical Care Registered Nurse certification on patient complications for children undergoing congenital heart surgery in free-standing children's hospitals in the United States.DesignA cross-sectional descriptive survey of nursing and organizational characteristics was sent electronically.SettingFree-standing children's hospitals in the United States.PatientsChildren undergoing congenital heart surgery (congenital cardiac cases).InterventionNursing and unit characteristics from children's hospitals were obtained via electronic survey during years 2010 and 2014. Survey data from 2014 were linked with patient-level data age less than 18 years old using the Pediatric Health Information System for years 2013-2014. The Complication Screening Method of Congenital Heart Surgery was used to adjust for baseline patient differences.Measurements And Main ResultsAmong 23 of 43 free-standing children's hospitals (53%) in 2014, the median proportion of nurses with Bachelor of Science in Nursing preparation or higher at each site was 77% and with Critical Care Registered Nurse certification was 24%. Among 12,324 eligible congenital cardiac cases, the rate of complication was 34.4%. The odds of complications significantly decreased as the institutional percentage of nurses with a Bachelor of Science in Nursing increased (odds ratio, 0.83; p = 0.04). The odds of complications also significantly decreased as the institutional percentage of nurses with Critical Care Registered Nurse certification increased (odds ratio, 0.86; p = 0.02).ConclusionsBachelor of Science in Nursing education and Critical Care Registered Nurse certification significantly impact pediatric patient outcomes. Recognition of nursing and organizational characteristics that are associated with improved pediatric patient outcomes is important to patients, their families, and society. Clinical leaders must commit to facilitating pathways for hiring candidates with Bachelor of Science in Nursing as a minimum to practice in PICUs and supporting a culture of professional certification.

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