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http://dx.doi.org/10.4332/KJHPA.2007.17.2.068

The Effects of Institutional and Market Factors on Nurse Staffing in Acute Care Hospitals  

Kim, Yun-Mi (Dept. of Nursing, Eulji University)
Cho, Sung-Hyun (Dept. of Nursing, Hanyang University)
Jun, Kyung-Ja (Dept. of Nursing, Soonchunhyang University)
Go, Su-Kyung (Health Insurance Review Agency)
Publication Information
Health Policy and Management / v.17, no.2, 2007 , pp. 68-90 More about this Journal
Abstract
Nurse staffing level is an important factor that influences the quality of health service and patient outcomes. This study was carried out to examine the current state of acute hospital nurse staffing and find out factors that affect the nurse staffing level. Nurse staffing of individual hospitals was measured using the number of registered nurses per 100 beds. Descriptive and multiple regression analyses were conducted using 592 acute care hospitals' data. Regression model included structure factors such as referral level, ownership, medical and general staffing, and financial outcome factors such as occupancy rate, inpatient and outpatient revenues. Market characteristics included strength of competition, supply of nurses, and income and health status level of consumers. The average number of nurses per 100 beds was 28 and showed a great variation according to the referral level. Regression model explained this variation as much as 76.87%. Hospital structure variables which affecting the hospital nurse staffing level positively were ICU bed ratio, the staffing level of specialist, training doctor and employees except doctor and nursing personnel, while the negative factor was nurse aid staffing level. General hospitals employed more nurses than hospitals. Among outcome characteristics, occupancy rate and the amount of health insurance inpatient revenue affected positively on the hospital nurse staffing level. The more supply of the new nurse and the higher consumer income and health status in the medical service markets, the more nurses were employed by the medical institutes. According to the study result, hospitals employed more nurses when they had more financial incentive by increasing nurses. This means appropriate hospital incentive policy and regulation policy, which hospital violate nurse staffing level have to pay penality, should be needed. Clarifying job description between nurses and nurse aids and the reentry program for unemployed experienced nurses will be helpful to increase nurse staffing level.
Keywords
Nurses; Hospital nursing staff; Health service marketing;
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1 Blegen MA. Nurse staffing and patient outcomes. Nuris Res 1998;47(1):43-50   DOI
2 Bond CA, Raehi L, Pitterle MF, Franke T. Health care professional staffing, hospital characteristics and hospital mortality rates. Pharmacotherapy 1999;19(2):130-138   DOI
3 Mark BA, Salyer J, Wan TTH. Market, hospital and nursing unit characteristics as predictors of nursing unit skill-mix : A contextual analysis. J Nurs Adm 2000;30(1):552-560   DOI   ScienceOn
4 김윤미. 종합전문병원의 간호사 확보수준에 영향을 미치는 요인. 간호행정학회지 2000;6 (1):147-159
5 대한간호협회. 간호통계연보. 서울:대한간호협회;2004
6 병원간호사회. 사업보고서. 서울:병원간호사회;2006
7 건강보험심사평가원. 의료기관종별 구분개선에 따른 의료기관종별 인정평가기준 개발 .2006
8 양봉민. 보건경제학. 서울:나남출판사;1999
9 이진경. 건강보험 본인부담실태와 추이분석. 서울:건강보험연구센터;2002
10 Aiken LH. Outcomes of nursing:An international perspective. Available from: URL:http://www.icn.ch/geneva/Aiken_presentation_files(2004.7.26 retrieved)
11 Aiken LH, Clark SP, Sloane DM, Sochala SKJ, Silber JH. Hospital nurse staffing and patient mortality, nurse burn out and job dissatisfaction. JAMA 2002;288(16):1987-1993   DOI   ScienceOn
12 American Nurses Association. RN staffing ratios : avilable form : URL:http://www.calnurse. org/?Action (2004. 12. 8 retrived)
13 Aiken LH, Clark SP, Sloane DM. Hospital restructuring:Does it adversely affect care and outcomes?. J Health Serv Adm 2001;23(4):416-442
14 Aiken LH. The hospital nursing shortage:A paradox of increasing supply and increasing vacancy rate. Wesr J Med 1989;151:87-92
15 American Nurses Association. 2005 Legislation : Staffing plans & Ratios. URL:http://www.nursingworld.org/gova/state/2005/staffing.htm. (2006.11.9 retrived)
16 American Nurses Association and Network Inc. Implementing nursing's report card:A study of RN staffing, length of stay and patient outcomes. Washington, DC; American Nurses Publishing:1997
17 Becker E, Foster R. Organizational determinants of nurse staffing patterns. Nurs Econ 1988;6(2):71-75
18 Kanda K, Kodama S. Determinants of nursing service in urban public hospital:an economic perspective. Nurs Health Sci 2002;4(3):63-72   DOI   ScienceOn
19 Brewer CS, Frazier P. The influence of structure, staff type and managed care indicators on registered nurse staffing. J Nurs Adm 1998;28(9)28-36
20 Buchan J. A Certain ratio? Minimum staffing ratios in nursing? A Report for the Royal college of nursing. 2004
21 Buerhaus PI, What is the harm in imposing mandatory hospital nurse staffing regulations? Nurs Econ 1997; 15(2): 66-72
22 Buerhaus PI, Economic pressure building in the hospital employed RN labour market. Nurs Econ 1995; 13(3): 137-141
23 Cho SH, Kim HR. Family and paid caregivers of hospitalized patients in Korea. J Clin Nurs 2005;14:1-8
24 Coffmann J, Spetz J, Maintaining and adequate supply of RNs in California. Image J Nurs Sch 1993;31(4):389-393   DOI
25 Lichtig LK, Knauf RA, Milhiolland DK. Some impacts of nursing on acute care hospital outcomes. J Nurs Adm 1999;29(2):25-33
26 Hartz A, Krakauer H, Kuhn E et al. Hospital characteristics and mortality rate. N Engl J Med 1989;321(25):1720-1725   DOI   ScienceOn
27 Hirsch BT, Schumacher EJ. Monopsony power and relative wages in the labourmarket for nurses. J Health Econ 1955;14(4):443-476   DOI   ScienceOn
28 Kim YM, Cho SH, June KJ. Factors related to nurse staffing levels in tertiary and general hospitals. Taehan Kanoh Hakhoe Chi 2005;35(8)1493-1499   과학기술학회마을   DOI
29 Manhein LM, Feinglass J, Shortell SM, Hughes Edward FX. Regional variation in medicare hospital mortality. Inquiry 1992;29:55-66
30 Mark BA, Harless DW, McMue M, Xu Y. A longitudinal examination of hospital registered nurse staffing and quality of care. Health Serv Res 2004;39(2):279-300
31 OECD.2002 OECD Health Data. 2004
32 Pattern C. The economic value of nursing. Nurs Econ 1992;10(3):193-204
33 Prescott P. The enigmatic nursing workforce. J Nurs Adm. 2000;30(2):59-65   DOI   ScienceOn
34 Robinson JC. Market structure , employment and skill-mix in the hospital industry. Southern Econ J 1988;55:315-325   DOI   ScienceOn
35 Sloan FA, Richupan S. Short-run supply responses of professional nurses : A microanalysis. J Hum Resour. 1975;10(2):241-257   DOI
36 Spetz J. The effect of managed care and prospective payment on the demand for hospital nurse:evidence from California. Health Serv Res 1999;34(5th):993-1010
37 Steven S, Mike. V, Jeremy H, Tackling Nurse Shortage in OECD Countries , OECD Health Working Papers. 2005;19
38 Mobley LR, Magnussen J. The impact of managed care penetration and hospital quality on efficiency in hospital staffing. J Health Care Financ 2002;28(42):24-42
39 Unruh L. The effect of LPN reduction on R N patient Load. J Nurs Adm 2003;33(4):201-208   DOI   ScienceOn
40 Wharrad H, Robinson JC. The global distribution of physicians and nurses. J Adv Nurs 1993;30(1):109-120   DOI
41 Zimmermann PG. Replacement of nurses with unlicensed assisitive personnel : The erosion of professional nursing and what can we do? J Emerg Nurs 1995;21(3):208-212   DOI   ScienceOn
42 Monrad A Incentives and financing methods, Health Policy 1995; 34: 205-220   DOI   ScienceOn
43 Aiken LH, Smith HL, Lake ET. Lower medical mortality among a set of hospitals known for good nursing care. Med Care 1994;32(8):771-787   DOI   ScienceOn
44 Kovner C, Gergen PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch 1998;30(4):315-321   DOI   ScienceOn