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Study: Nurses’ work environment affects rate of babies discharged from NICU on breast milk

A study in the International Journal of Nursing Studies concludes when NICU nurses have better work environments and higher education levels (at least a BSN) and the units are adequately staffed, more babies are discharged on breast milk, according to a news release. NICUs with better work environments allow nurses time and resources and have more supportive nurse managers and collaborative working relationships between nurses and physicians. These factors enhance nurses’ ability to provide breastfeeding support, which significantly increases the percentage of infants who receive breast milk.

Breast milk is widely recognized as the best form of nutrition for infants, particularly premature babies and those with low birth weights. Despite that, 52% of very low birth weight infants are discharged from neonatal NICUs on formula only and 42% are discharged on breast milk with a fortifier or formula, according to the release.

This study was based on data generated by an earlier study funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. The new study was led by Sunny Hallowell, PhD, PPCNP-BC, IBCLC, assistant professor at Villanova University School of Nursing.

The research team conducted secondary analysis of INQRI-funded nurse survey data from 5,614 nurses and breast milk discharge rates in 97 NICUs. These units cared for 6,997 very low birth weight infants (between 501 and 1500 grams at birth). The NICUs were part of the Vermont Oxford Network, a NICU quality improvement collaborative.

Several other factors, including the presence of lactation consultants, did not have a significant impact on the proportion of infants discharged on breast milk, according to the release. “Breastfeeding support by registered nurses had the largest impact on whether infants were receiving breast milk at discharge,” Eileen T. Lake, PhD, RN, FAAN, an INQRI research team leader, said in the release. “However, nursing unit factors — notably education levels and good work environment — also produced higher rates of breastmilk at discharge. Our findings speak to the importance of hospitals investing in better work environments and better educated nurses to increase the rate of infants discharged on breast milk, which provides them with the best nutritional care and the healthiest start in life.”

Other members of the research team were: Jeannette Rogowski, PhD, university professor in health economics in the Department of Health Systems and Policy at the Rutgers School of Public Health; Diane Spatz, PhD, RN-BC, FAAN, professor of perinatal nursing and Helen M. Shearer Term Professor of Nutrition at the University of Pennsylvania School of Nursing; Alexandra Hanlon, PhD, research professor of Nursing at the University of Pennsylvania School of Nursing; and Michael Kenny, MS, public health analyst, Vermont Department of Health.

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By | 2020-04-15T16:21:26-04:00 December 10th, 2015|Categories: Nursing News|4 Comments

About the Author:

Sallie Jimenez
Sallie Jimenez is content manager for healthcare for from Relias. She develops and edits content for the blog, which covers industry news and trends in the nursing profession and healthcare. She also develops content for the Digital Editions. She has more than 25 years of healthcare journalism, content marketing and editing experience.


  1. Avatar
    Pamela Kerber BSN, RNC-NIC, IBCLC December 24, 2015 at 5:02 am - Reply

    I agree with the article with regards to education to a certain extent. However, I find that time is the most common determinant of how successful we are in the NICU with supporting and educating mother’s in their breast feeding experiences. As an IBCLC in the NICU, I spend at least 30 minutes or more at a time working with an individual mom and infant to educate, facilitate a successful latch, and support her efforts. Combine this with either a full patient load or charge duties, it is VERY difficult for nurses to meet this type of demand. Compounding this is electronic charting which is quite time consuming on its own. Currently, our manager does not feel the need for a full-time LC, therefore these mom’s are left to sink or swim many days out of the week.

    • Avatar
      Linda Kennedy December 28, 2015 at 2:34 am - Reply

      I am in the same boat at our smaller hospital because our efforts are huge but ratios between pt n nurse especially in the labor and del area is rarely what is recommended by our regulators like ACOG. No sentinel events have taken place but scheduled inductions at 39 weeks with very low bishop scores are continued to be allowed. I tried to follow the chain of command and even talked to our chief nurse officer and nothing changed one bit. I love my patients and my job and that is what keeps me there. I have lives thru many changes but the moral is rivk bottom but no one wants to stand together on the issues because they are friends with the nurse manager.

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    Heather December 29, 2015 at 4:26 pm - Reply

    I became an IBCLC just over 5 years ago, before I had kids. My second baby was born a little over a year ago at 31 weeks gestation. The pregnancy was healthy and normal all the way until I went into labor, it was not expected and I was not high risk. Our little girl was in the NICU for 27 days. It was difficult for me because hospital policies were against my education. But I was conflicted that if we tried to fight policy and advocate for exclusive breastmilk and no fortifiers that it may delay her release from the NICU. We also dealt with the constant changing of the neonatologist and each one had a different viewpoint. One only allowing us to try breastfeeding once she was 34 weeks and then only one feeding a day, the next encouraging all breastfeeding with no supplement needed. It was obvious the nurses were breastfeeding friendly but they couldn’t go against doctors orders. I never mentioned I was an IBCLC while in the NICU and while we did see the IBCLC on staff, we only saw her twice in the 27 days. We got more feeding support from the nurses and the occupational therapist who showed us how to bottle feed our baby. From my single perspective it didn’t have anything to do with education but more with experience and the ability to speak against doctors orders.

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    Lori January 24, 2016 at 7:17 pm - Reply

    I’m not sure how having a BSN makes you better at knowing that breast is best. I think being a nurse for 27 years in NICU AND a mother gives me a little better advantage than a brand new BSN nurse with no experience. Not having a BSN doesn’t give me less knowledge. It only gives one initials behind your name and the ability to be able to write a nice report. Adequately staffed units and the ability to use the resources available like the lactation educators and good support from your bedside nurses makes mother’s more comfortable in exploring that avenue for their child. We all know it’s the best thing for preemies and sick babies, but there are always extenuating circumstances in some cases where donor human milk isn’t available. Having a BSN or not doesn’t make you any less or more knowledgeable in that regard.

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