Nurse staffing levels on the NPICU in the island of Malta.

. Nurse staffing levels in neonatal paediatric intensive care units (NPICU) are often inadequate. Malta is a small Island in the centre of the Mediterranean (total population around 400,000) with a birth rate of just under 4000/annum, with one NPICU. This study analysed nurse staffing levels for a 1 year period in order to ascertain whether said levels are adequate or not. . Daily ward occupancies were classified by level of dependency, and ideal nursing requirements were estimated using internationally approved standards, on a daily basis, for the period 12 month period from 01/04/2008 to 31/03/2009. These were compared with the actual daily morning nursing levels to estimate deficit/s. . There were a total of 373 admissions to the unit resulting in a total of 5464 patient days (daily census at 0700 hrs) and 1471 free bed days (occupancy 78.8%). Occupancy varied between 8 and 23 patients (mean 15). Staffing levels ranged between 7 and 17 nurses (mean 11). The overall mean deficit was of 3.3 nurses, but this ranged from a maximum of 11 to a rare surplus of 7 nurses. . This study only focused on a daily morning snapshot where the nursing staff is at its peak number - the nocturnal deficit is naturally worse. Furthermore, experience levels vary due to short rotations through the unit of inexperienced midwifery staff. Moreover, there are no staff designated as responsible for further education and training, extra staff for unpredictable high dependency situations, to compensate for leave, sickness, maternity leave, study leave, staff training and attendance at meetings. Clearly, the Maltese NPICU is overall understaffed.