Introduction: Inpatient maintenance of glycemic control relies heavily on nurse-directed care. In July 2018, our academic medical center experienced a nursing strike. Replacement staff were employed during the strike. The purpose of this study was to investigate the impact of a disrupted nursing workforce on glycemic control of hospitalized patients with diabetes.
Methods: This was a retrospective cohort study of glycemic control during a nursing strike. Data included three, 48-hour periods: pre-strike, strike, and post-strike. All adult hospitalized patients with diabetes were eligible. Patients were excluded if they were in the intensive care unit. The primary outcome was the frequency of hyperglycemia, defined as average percentage of point-of-care finger stick tests > 180 mg/dL per patient. Hypoglycemia was defined as average percentage of tests < 70 mg/dL per patient. Data were analyzed using Wilcoxon rank sum tests with P<0.05 considered statistically significant.
Results: Two hundred and eleven patients were included in the analysis: 65 patients (30.8%) in the strike period and 146 patients (69.2%) during the comparative periods. There were no differences in age, sex, race, or body mass index between groups. During the strike period, a mean of 35.5% of patients’ glucose tests met criteria for hyperglycemia, versus a mean of 31.2% of tests in the comparative periods (P=0.46). A mean of 1.4% of glucose tests met criteria for hypoglycemia during the strike period, versus a mean of 0.2% during normal operations (P=0.02).
Conclusions: Hyperglycemia did not vary significantly with a short-term disruption in nursing workforce. There was a suggestion of increased hypoglycemia, however this was a rare event and should be interpreted with caution.
K. Sheahan: None. B. Tompkins: None. A.G. Kennedy: None. A.B. Repp: None. M.P. Gilbert: Advisory Panel; Self; Corcept Therapeutics. Consultant; Self; Novo Nordisk Inc.