Browse > Article
http://dx.doi.org/10.4040/jkan.2012.42.5.719

Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients  

Kim, Yunmi (Department of Nursing, Eulji University)
Cho, Sung-Hyun (College of Nursing, The Research Institute of Nursing Science, Seoul National University)
June, Kyung Ja (Department of Nursing, Soonchunhyang University)
Shin, Soon Ae (Department of Health Promotion & Management, National Health Insurance Corporation)
Kim, Jiyun (Department of Nursing, Gachon University)
Publication Information
Journal of Korean Academy of Nursing / v.42, no.5, 2012 , pp. 719-729 More about this Journal
Abstract
Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.
Keywords
Personnel staffing; Nursing administration research; Outcomes research;
Citations & Related Records

Times Cited By Web Of Science : 0  (Related Records In Web of Science)
연도 인용수 순위
  • Reference
1 Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., et al. (2010). Implications of the California nurse staffing mandate for other states. Health Service Research, 45, 904-921. http://dx.doi.org/10.1111/j.1475-6773.2010.01114.x   DOI
2 Cho, S. H. (2001). Nurse staffing and adverse patient outcomes: A systemic approach. Nursing Outlook, 49, 78-85. http://dx.doi.org/10.1067/mno.2001.114381   DOI
3 Cho, S. H., Hwang, J. H., & Kim, J. (2008). Nurse staffing and patient mortality in intensive care units. Nursing Research, 57, 322-330. http://dx.doi.org/10.1097/01.NNR.0000313498.17777.71   DOI
4 Cho, S. H., June, K. J., Kim, Y. M., & Park, B. H. (2008). Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. Journal of Korean Academy of Nursing Administration, 14, 167-175.
5 Ministry of Health and Welfare. (2006, Dec 18). Standard of medical care benefit and resource-based relative value scale of medical procedure. Retrieved January 19, 2011, from http://www.mohw.go.kr/front/jb/sjb0402vw.jsp?PAR_MENU_ID=03&MENU_ID=030402& BOARD_ID=220&BOARD_FLAG=03&CONT_SEQ=39840&page=1
6 Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2001). Nurse staffing and patient outcomes in hospitals (Contract No. 230-990021). Boston: Harvard University.
7 Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., & Mattke, S. (2006). Nurse-staffing in hospital: Is there a business case for quality? Health Affairs, 25, 204-211. http://dx.doi.org/10.1377/hlthaff.25.1.204   DOI
8 Newbold, D. (2008). The production economics of nursing: A discussion paper. International Journal of Nursing Studies, 45, 120-128. http://dx.doi.org/10.1016/j.ijnurstu.2007.01.007   DOI
9 Newhouse, R. P., Johantgen, M., Pronovost, P. J., & Johnson, E. (2005). Perioperative nurses and patient outcomes-mortality, complications, and length of stay. AORN Journal, 81, 508-528. http://dx.doi.org/10.1016/S0001-2092(06)60438-9   DOI
10 Oman, K. S., Makic, M. B., Fink, R., Schraeder, N., Hulett, T., Keech, T., et al. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 40, 548-553. http://dx.doi.org/10.1016/j.ajic.2011.07.018   DOI
11 Park, O. Y., & Jung, M. S. (2005). Analysis of the nursing interventions performed in the medical & surgical units and the health insurance cost items based on the NIC. Journal of Korean Academy of Nursing Administration, 11(4), 1-19.
12 Park, S. H. (2003). Analysis of direct nursing activity and patient outcomes related to graded fee of nursing management for inpatient. Journal of Korean Academy of Nursing, 33, 122-129.   DOI
13 Halm, M., Peterson, M., Kandels, M., Sabo, J., Blalock, M., Braden, R., et al. (2005). Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. Clinical Nurse Specialist, 19(5), 241-251. http://dx.doi.org/10.1097/00002800-200509000-00007   DOI
14 Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. The Journal of the American Medical Association, 290, 1617-1623. http://dx.doi.org/10.1001/jama.290.12.1617   DOI
15 Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288, 1987-1993. http://dx.doi.org/10.1001/jama.288.16.1987   DOI
16 Cho, S. H., Ketefian, S., Barkauskas, V. H., & Smith, D. G. (2003). The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nursing Research, 52, 71-79. http://dx.doi.org/10.1097/00006199 -200303000-00003   DOI
17 Health Insurance Review & Assessment Service. (2009). KDRG categorization. Seoul: Author.
18 Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007a). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45, 1195-1204. http://dx.doi.org/10.1097/MLR.0b013e3181468ca3   DOI
19 Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007b). Nurse staffing and quality of patient care. Evidence report/technology assessment No. 151 (Prepared by the Minnesota evidence-based practice center under contract No. 290-02-0009). Rockville: Agency for Healthcare Research and Quality.
20 Katz, M. H. (2006). Multivariable analysis: A practical guide for clinicians. Cambridge: Cambridge University Press.
21 van den Heede, K., Sermeus, W., Diya, L., Clarke, S. P., Lesaffre, E., Vleugels, A., et al. (2009). Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data. International Journal of Nursing Studies, 46, 928-939. http://dx.doi.org/10.1016/j.ijnurstu.2008.05.007   DOI
22 Ranji, S. R., Shetty, K., Posley, K. A., Lewis, R., Sundaram, V., Galvin, C. M., et al. (2007) Closing the quality gap: A critical analysis of quality improvement strategies (Vol. 6: Prevention of healthcare-associated infections). (Report No. 04(07)-0051-6). Rockville: Agency for Healthcare Research and Quality.
23 Rochefort, C. M., & Clarke, S. P. (2010). Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing, 66, 2213-2224. http://dx.doi.org/10.1111/j.1365-2648.2010.05376.x   DOI
24 Kim, Y. M. (2008). Nurse staffing level relating factors of the general nursing units, ICU, ER and OR in acute general hospitals. Journal of Korean Academy of Nursing Administration, 14, 404-412.
25 Sochalski, J. (2004). Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Medical Care, 42(Suppl 2), II67-II73. http://dx.doi.org/10.1097/01.mlr.0000109127.76128.aa
26 van den Heede, K., Clarke, S. P., Sermeus, W., Vleugels, A., & Aiken, L. H. (2007). International experts' perspectives on the state of the nurse staffing and patient outcomes literature. Journal of Nursing Scholarship, 39, 290-297. http://dx.doi.org/10.1111/j.1547-5069.2007.00183.x   DOI
27 Wald, H., Epstein, A., & Kramer, A. (2005). Extended use of indwelling urinary catheters in postoperative hip fracture patients. Medical Care, 43(10), 1009-1017. http://dx.doi.org/10.1097/01.mlr.0000178199.07789.32   DOI
28 Kim, Y. M., Kim, J. Y., June, K. J., & Ham, E. O. (2010). Changing trend in grade of nursing management fee by hospital characteristics: 2008-2010. Journal of Korean Clinical Nursing Research, 16, 99-109.
29 Korean Standard Statistical Classification. (n.d.). Classification of disease. Retrieved November 4, 2010, from http://kostat.go.kr/kssc/main/ MainAction.do?method =sub&catgrp =kssc&catid1 =kssc03
30 Kunin, C. M. (1984). Genitourinary infections in the patient at risk: Extrinsic risk factors. The American Journal of Medicine, 76, 131-139. http://dx.doi.org/10.1016/0002-9343(84)90255-9   DOI