Pebbles of Hope speaks with Dr. Sunny Hallowell, an Assistant Professor of Nursing at Villanova University, in the latest episode of the Bridging the Gap podcast
Pebbles of Hope releases today the sixth episode of its podcast series, Bridging the Gap, in which we explore the issues affecting NICU families in underserved communities. This latest episode features Dr. Sunny Hallowell, an Assistant Professor of Nursing and Researcher at Villanova University College of Nursing. In this episode, Cheryl Chotrani, Executive Director of Pebbles of Hope, speaks with Dr. Hallowell to discuss the impact of NICU staffing on the outcomes of babies. A condensed version of our conversation is below.
Please share with us your career path and what led you to the field of neonatal nursing and your research focus on breastfeeding and NICU staffing.
Dr. Hallowell: I started my career as a pediatric transplant nurse, which means I cared for sick children recovering from organ transplant surgery. When I came to the US, I began to develop an interest in what these children would look like from the moment of birth. That led me to the neonatal intensive care unit, which I discovered was a very unique clinical environment. I had the great opportunity to work in the postpartum unit at the University of Pennsylvania health system after completing my master’s degree in nursing there. It was apparent to me that the most important thing that a new mother has to do after giving birth is feed her infant, and that is how I got interested in the process of breastfeeding or human milk provision.
Some of your recent research focuses on the association between the hospital workforce and the outcomes of infants in the NICU. I was wondering if you could talk about some of your key findings.
Dr. Hallowell: What we have learned in a huge body of research is that nurses are critical partners within a hospital setting. That may be even more the case when infants are admitted to the NICU. Even if you have explained to a mother before she gives birth what it would be like having a baby in the NICU, or even if that mother has read articles or books about prematurity, it is still usually an unexpected event when it happens. Nurses are there to work with the parents to bridge the communication between complex medical things that may be happening to their child and the reality of just being a parent. As part of that role, nurses are often the first to have a conversation with the new mother about how she would like to feed her baby. Breast milk provides so many health benefits for both the mother and baby that if the nurse can help the mother to at least try providing breast milk, they are serving a really important role. So, when we look at whether or not nurses have the capacity to assist new mothers effectively in the NICU, we could be doing a much better job.
In my work, using a national sample of hospitals including 6,000 nurses caring for over 15,000 infants, only about 14% of those nurses reported providing breastfeeding support. There could be many reasons for this, but we also know that of the babies that are discharged, only 42% of them are receiving breast milk and only 6% are on an exclusive human milk diet. That’s well below the goal for babies being discharged on human milk. Staffing is a very important factor in whether or not nurses are able to provide breastfeeding support, as would be expected. The question of my most recent research was how often are parents in the NICU and how does staffing in the NICU affect that? What I found was that it wasn’t NICU staffing that pulled the lever on how much time parents spent in the NICU. What surprised us was that the most significant factor was nursing leadership and whether or not nurses were empowered to participate in hospital governance. When nurses have a say in clinical-level practices and can help implement more family-centered policies, such as an open visitation policy, allowing parents to participate in rounds, and facilitating ways for parents to more actively participate in their baby’s care, parents respond by becoming more involved. So, when hospitals invest in their nursing staff and provide them with the proper training and opportunities to participate in leadership, parents and their babies benefit from that.
Your research looked across NICUs at a nationwide level. How might the findings differ when looking specifically at hospitals in underserved communities?
Dr. Hallowell: In my research, I didn’t really look at how well resourced the hospitals were that we evaluated. But, I can tell you about what I believe is the best way that hospitals in less resourced areas could improve their outcomes. Smaller hospitals may benefit from partnering with larger institutions to gain access to evidence-based practices that they can implement in their NICU. Providing opportunities for their nurses to learn about the latest techniques, whether it be through partnerships or sending them to conferences, is probably the most important thing they can do to improve outcomes. In doing that, they improve the level of training of their nurses and also expand the pool of talent that they can attract to work at their hospital. I’ve personally witnessed hospitals in underserved areas where nurses are expertly trained, and despite having access to fewer resources, can sometimes achieve results as good as hospitals in other locations.
In addition to partnerships and nurse training, there also seems to be an important role for technology to play. How can hospitals better leverage technology to improve outcomes?
Dr. Hallowell: The advent of technologies like the double-walled isolette, and other medical and pharmacological innovations, have significantly decreased the mortality and morbidity of babies in the NICU over the last several decades. In terms of using technology to alleviate nursing shortages, however, my view is that the only way to really address this is to invest in human capital. There are, however, many programs that are helpful for staffing scheduling, and what really needs to be developed is a responsive staffing model that can predict staffing needs. One of the most innovative things that I’m seeing in the NICU now is the idea of using cameras to allow nurses to communicate with parents that can’t be at the bedside. This allows a means for parental surveillance when they are unable to be there and gives moms a chance to see their babies enabling them to produce more milk. Technologies like this can be really important for us to examine and gather more evidence to see how they can be optimized.
Are there things that governments or other organizations are doing now to address staffing gaps in certain parts of the country? Or are there more thing that could be done to address nursing shortages?
Dr. Hallowell: One of the major factors influencing changes in healthcare right now is the accelerating rate of registered nurse retirement. When those nurses retire, we’re losing a huge group of potential mentors for new nurses. We need that human capital to provide the history and knowledge formed through years of delivering evidence-based care to our novice nurses just entering the profession. That retirement of over 1 million nurses in the next decade is going to coincide with the retirement of physicians as well. So what can be done about this? One strategy is to eliminate barriers to full practice authority for nurse practitioners. For over 50 years, nurse practitioners have been providing high quality, cost-effective care to Americans across the country, so they can be a very important resource for expanding access to care. Another way of addressing nursing shortages is to help nurses pay for their education. Investing in nurse training and education would encourage more people to enter the field and also translates into better outcomes for patients.
The full audio copy of this episode as well as all other episodes of the Bridging the Gap podcast is available on iTunes, Google Play or wherever you get your podcasts.