The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

Abstract

Introduction Hyperglycemia and hypoglycemia have been found to increase morbidity and mortality among hospitalized patients with diabetes. In July of 2018, our academic medical center experienced a 48-hour nursing strike, during which time 600 replacement nurses were employed. This cohort study evaluated the impact of the nursing strike on glycemic control among hospitalized patients with diabetes. Methods Point-of-care fingerstick blood glucose (POC BG) values among hospitalized patients with diabetes were compared between the 48-hour nursing strike period and two 48-hour periods when the nursing strike did not occur. We evaluated the percentage of POC BG values that were hyperglycemic (POC BG 181-250 mg/dL), severely hyperglycemic (POC BG >250 mg/dL), and hypoglycemic (POC BG <70 mg/dL). Additionally, we assessed the proportion of patients who experienced one or more days of hypoglycemia, hyperglycemia, or severe hyperglycemia. Results We found a significant association between the distributions of POC BG test results during the nursing strike; test results more frequently showed hyperglycemia, severe hyperglycemia, or hypoglycemia during the nursing strike than during the control period (p=0.006). There was a significant difference in the days of hypoglycemia, with 7.7% of patients experiencing one or more days of hypoglycemia during the strike period compared with 1.4% of patients during the control period (p=0.03). Conclusion Nursing strikes have been employed as a last resort in contract negotiations with hospitals, but they have the potential to significantly affect patient care and safety. Further studies are needed to evaluate these impacts to prepare for future workforce disruptions.

Keywords: diabetes treatment; endocrinology and diabetes; inpatient care; medical workforce; nursing staff.