Browse > Article
http://dx.doi.org/10.4040/jkan.2014.44.1.21

Impact of Nurse, Nurses' Aid Staffing and Turnover Rate on Inpatient Health Outcomes in Long Term Care Hospitals  

Kim, Yunmi (College of Nursing, Eulji University)
Lee, Ji Yun (Department of Nursing, Kangwon National University)
Kang, Hyuncheol (Department of Informational Statistics, Hoseo University)
Publication Information
Journal of Korean Academy of Nursing / v.44, no.1, 2014 , pp. 21-30 More about this Journal
Abstract
Purpose: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. Methods: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Results: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. Conclusion: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
Keywords
Nurse staffing; Registered nurse; Patient outcome; Turnover; Long term care;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Zinn JS, Aaronson WE, Rosko MD. Variations in the outcomes of care provided in Pennsylvania nursing homes. Facility and environmental correlates. Medical Care. 1993;31(6):475-487.   DOI
2 Castle NG. Nursing homes with persistent deficiency citations for physical restraint use. Medical Care. 2002;40(10):868-878. http://dx.doi.org/10.1097/01.mlr.0000027357.74348.20   DOI
3 Harrington C, Swan JH. Nursing home staffing, turnover, and case mix. Medical Care Research and Review. 2003;60(3):366-392; discussion 393-369. http://dx.doi.org/10.1177/1077558703254692   DOI
4 Bostick JE. Relationship of nursing personnel and nursing home care quality. Journal of Nursing Care Quality. 2004;19(2):130-136.   DOI
5 Hendrix TJ, Foreman SE. Optimal long-term care nurse-staffing levels. Nursing Economics. 2001;19(4):164-175.
6 Castle NG, Engberg J. Staff turnover and quality of care in nursing homes. Medical Care. 2005;43(6):616-626.   DOI
7 Lee JY, Park EK, Yoon JY, Song SH. The current status of long-term care hospital. Seoul: Health Insurance Review & Assessment Service, 2007 December. Report No.: K42-2007-51.
8 Health Insurance Review & Assessment Service. Information of benefit criteria [Internet]. 2010 [cited 2013 August 1]. Available from: http://www.hira.or.kr/dummy.do?pgmid=HIRAA030010000000.
9 Lee JY, Kim EY, Cho E. Factors impacting the physical function of older adults in Korean long-term care hospitals. Journal of Korean Academy of Nursing. 2011;41(6):780-787. http://dx.doi.org/10.4040/jkan.2011.41.6.780   DOI
10 Yoon JY, Lee JY, Bowers BJ, Zimmerman DR. The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: A longitudinal correlational study. International Journal of Nursing Studies. 2012;49(12):1544-1551. http://dx.doi.org/10.1016/j.ijnurstu.2012.07.011   DOI
11 Lee SH. Multi-level analysis of factors related to quality of service in long-term care hospitals. Journal of Korean Academy of Nursing. 2009;39(3):409-421. http://dx.doi.org/10.4040/jkan.2009.39.3.409   DOI
12 Collier E, Harrington C. Staffing characteristics, turnover rates, and quality of resident care in nursing facilities. Research in Gerontological Nursing. 2008;1(3):157-170. http://dx.doi.org/10.3928/00220124-20091301-03   DOI
13 Zinn JS, Weech RJ, Brannon D. Resource dependence and institutional elements in nursing home TQM adoption. Health Services Research. 1998;33(2 Pt 1):261-273.
14 Mukamel DB, Spector WD, Limcangco R, Wang Y, Feng Z, Mor V. The costs of turnover in nursing homes. Medical Care. 2009;47(10):1039-1045. http://dx.doi.org/10.1097/MLR.0b013e3181a3cc62   DOI
15 Katz MH. Multivariable analysis: A practical guide for clinicians. London, UK: Cambridge University Press; 2006.
16 Corazzini KN, Anderson RA, Rapp CG, Mueller C, McConnell ES, Lekan D. Delegation in long-term care: Scope of practice or job description? The Online Journal of Issues in Nursing. 2010;15(2):Manuscript 4. http://dx.doi.org/10.3912/OJIN.Vol15No02Man04
17 Flynn L, Liang Y, Dickson GL, Aiken LH. Effects of nursing practice environments on quality outcomes in nursing homes. Journal of the American Geriatrics Society. 2010;58(12):2401-2406. http://dx.doi.org/10.1111/j.1532-5415.2010.03162.x   DOI
18 Song HJ, Chae JM, Park J. Development of payment for performance model according to evaluation of benefit adequacy of long term care hospitals. Seoul: Health Insurance Review & Assessment Service, 2013 May. Report No.: F88-2013-45.
19 Health Insurance Review & Assessment Service. Evaluation report of long term care hospitals in third year. Seoul: Author; 2011.
20 Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, et al. Nursing home quality, cost, staffing, and staff mix. The Gerontologist. 2004;44(1):24-38.   DOI   ScienceOn
21 Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, et al. Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. BMJ British Medical Journal. 2009;339:b2732. http://dx.doi.org/10.1136/bmj.b2732   DOI
22 Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies. 2011;48(6):732-750. http://dx.doi.org/10.1016/j.ijnurstu.2011.02.014   DOI   ScienceOn
23 Castle NG, Anderson RA. Caregiver staffing in nursing homes and their influence on quality of care: Using dynamic panel estimation methods. Medical Care. 2011;49(6):545-552. http://dx.doi.org/10.1097/MLR.0b013e31820fbca9   DOI   ScienceOn
24 Bostick JE, Rantz MJ, Flesner MK, Riggs CJ. Systematic review of studies of staffing and quality in nursing homes. Journal of the American Medical Directors Association. 2006;7(6):366-376. http://dx.doi.org/10.1016/j.jamda.2006.01.024   DOI   ScienceOn
25 Arling G, Kane RL, Mueller C, Bershadsky J, Degenholtz HB. Nursing effort and quality of care for nursing home residents. The Gerontologist. 2007;47(5):672-682.   DOI
26 Zhang X, Grabowski DC. Nursing home staffing and quality under the nursing home reform act. The Gerontologist. 2004;44(1):13-23.   DOI   ScienceOn