Study challenges conventional thought on nurse continuity in ICUs

PHILADELPHIA (March 5, 2025) – A new Penn Nursing study published in the Annals of the American Thoracic Society challenges conventional thought regarding the benefits of continuity in nursing care within intensive care units (ICUs). The researchers found that increased nurse continuity was not associated with a reduction in in-hospital mortality – in some shifts, it was even linked to a modest but statistically significant increase in mortality.

Researchers defined “cumulative nurse continuity” as the proportion of 12-hour shifts during which a patient was cared for by a nurse who had previously attended to them. Although overall continuity increased over time, the data revealed that higher continuity was not associated with improved patient outcomes, prompting a re-examination of its presumed benefits. This retrospective cohort study analyzed electronic health records from 47,564 ICU patients across 38 ICUs in 18 hospitals between 2018 and 2020.

 “Nurse continuity is often valued in the ICU, but our findings suggest it does not necessarily translate into improved patient outcomes,” said lead author Kathryn Connell, PhD, RN, CCRN, Assistant Professor in the Department of Biobehavioral Health Sciences; Core Faculty at the Center for Health Outcomes and Policy Research; Affiliated Faculty at the Palliative and Advanced Illness Research Center; Senior Fellow at the Leonard Davis Institute of Health Economics; and Clinical Nurse 2 at Pennsylvania Hospital. “Our findings indicate that the relationship between nurse continuity and patient outcomes is more complex than previously assumed. Further research is essential to explore the underlying factors contributing to these unexpected results.”

The study's conclusions remained consistent across multiple sensitivity analyses, including analyses limited to mechanically ventilated patients, excluding patients admitted during the COVID-19 pandemic, and using alternative measures of continuity.

Co-authors included Billie S. Davis, PhD, from the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine, and Jeremy M. Kahn, MD, MS, from the Department of Health Policy & Management at the University of Pittsburgh School of Public Health. Funding was provided by the National Institutes of Health under grants T32HL007820 and R35HL144804.

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