Preventing Inpatient NP Burnout: The Power of Adequate Staffing and Leadership.

BACKGROUND: Nurse practitioner (NP) burnout related to high patient-to-NP ratios needs to be addressed. OBJECTIVES: To survey inpatient pediatric NPs, assess burnout and characterize associated workload and support. DESIGN: Online cross-sectional survey conducted in three phases from March 2022 to August 2023. SUBJECTS AND SETTING: Inpatient specialty NPs from 32 hospitals. RESULTS: Fisher's exact test and logistic regression were implemented. A patient-to-provider (NP or resident) ratio of more than 5:1 was associated with NP burnout (OR = 3.5, 95% CI 1.0, 12.0 and OR = 4.1, 95% CI 1.1, 16.2, respectively, p < .05). Among NPs without burnout, 100% had organizational NP leadership (p = .012). INTERPRETATION: Though limited by a small convenience sample, a patient-to-provider ratio over 5:1 was associated with NP burnout, and NP leadership was protective. Further research of cost analysis, retention, and patient quality and safety measures are needed. CONCLUSION: Lower patient-to-NP ratios and NP leadership play a pivotal role in preventing burnout.

Are routine chest X-rays following chest tube removal necessary in asymptomatic pediatric patients?

PURPOSE: The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone. METHODS: A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. The primary outcome of the study was the need for intervention after CT removal. RESULTS: 102 patients had 116 CTs and met inclusion criteria; 79 post-pull CXRs were performed; the remaining 37 CT pulls did not have a follow-up CXR. No patients required CT replacement or surgery in the absence of symptoms. Three patients exhibited clinical symptoms that would have prompted intervention regardless of post-pull CXR results. One patient had an intervention guided by post-pull CXR results alone. Meanwhile, another patient had delayed onset of symptoms and intervention. No patients required an intervention in the group that did not have a post-pull CXR. CONCLUSION: Chest X-ray after CT removal had a very low yield for changing clinical management of asymptomatic patients. Clinical symptoms predict the need for an intervention.