• 간호행정학회지
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• 제9권4호
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• pp.559-569
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• 2003

Purpose: The purpose was to investigate nurse staffing levels and patient outcomes(nosocomial infection, patient fall, pressure ulcer). Method: The subjects of this study were 305 nurses from 20 general hospitals who worked at 39 medical and surgical wards. Self-reporting questionnaire which was developed by the writer through preceding study was used. In data analysis, SPSS WIN 10.0. program was utilized for descriptive statistics, ANOVA. Result: The mean of patient-to-nurse ration was 5.2:1. 65% among 20 hospitals was over 300 beds, 90 was located in urban area and 55 was private hospitals. Patient-to-nurse ration of hospitals in under 300 beds or rural area or private ownership was lower than hospitals in 300 beds or urban area or public ownership. 89.9 among 39 wards was medical or surgical wards. The mean of length of stay, 8-14 days got a majority and showed higher patient-to-nurse ration. Of the general characteristics, rural was significantly hight to patient fall(F=3.205, p<.05), medical unit was significantly high to patient fall, pressure ulcer(patient fall: F=8.890, p<.001, pressure ulcer: F=3.399, p<.05) and over 15 days was significantly higher than under 14 days of the mean of length of stay. And there was significant relationship between over 6.0:1 and over 4.0:1 to less than 5.0:1(F=4.817,p<.01). Conclusion: This study has shown a relationship between patient-to-nurse ration and patient fall using not objective research tool but self-reporting questionnaire. Therefore further research is needed to study using objective research tool. Based on this study, the effect of nurse staffing levels on patient outcome also has to be studied.

• 한국산학기술학회논문지
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• 제18권4호
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• pp.408-417
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• 2017

본 연구의 목적은 의료기관 간호사 확보수준이 수술한 암환자의 원내 사망과 원내 감염에 어떠한 영향을 미치는지 알아보고자 하였다. 이차자료를 이용하였으며, 2012년 상반기에 260개 의료기관에서 수술 후 사망률이 높은 6개 암으로 수술받은 암환자 24,510명을 대상으로 하였다. 단순 로지스틱 회귀분석과 일반화추정방정식(GEE) 모형을 이용하여 분석하였다. 환자 및 의료기관 특성(기관 종별 유형, 소재지, 수술건수)을 보정 후, 사망 가능성은 간호사 확보수준 0-1등급에 비해 2-3등급 군(odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11), 6-7등급 군(OR, 3.28; 95% CI, 1.87-5.74)에서 더 높은 것으로 나타났다. 병원 감염이 발생할 가능성은 간호사 1인당 침상수가 하나씩 증가할 때마다 증가하여, 0-1등급 군에 비해 2-3등급 군은 6.63배(95% CI, 3.00-14.62), 4-5등급 군은 5.79배(95% CI, 1.88-17.78), 6-7등급 군은 8.4배(95% CI, 1.82-38.84) 높은 것으로 나타났다. 낮은 간호사 확보수준은 환자안전과 의료의 질을 반영하는 지표인 높은 수술 후 원내 사망과 감염발생과 관련이 있었다. 이는 적절한 간호사 확보 수준은 수술 후 암 환자 결과와 관련 있음을 보여준다. 수술한 암환자의 의료의 질 향상과 환자 안전을 위해서는 적절한 간호사 수가 확보되어야 하며, 이를 위한 정책 유지가 필요하다.

• 문화기술의 융합
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• 제7권2호
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• pp.247-259
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• 2021

목적: Castle과 Engberg의 이론적 기틀을 활용하여 노인요양시설의 간호인력이 입소노인의 케어의 질과 삶의 질에 미치는 영향을 파악하고자 한다. 방법: 6개의 데이터베이스에서 "Nurse staffing(간호인력 배치)", "Nursing staff(간호인력)", "Outcome(결과)", "Quality of care(케어의 질)", "Quality of life(삶의 질)", "residents outcomes(입소자 결과)", "nursing home(노인요양시설)", "long-term care(장기요양)"를 키워드로 1996년 1월부터 2021년 3월까지 출판된 문헌을 수집하여 총 31편의 연구가 도출되었다. Castle과 Engberg의 이론적 기틀을 활용하여 체계적인 고찰을 수행하였다. 결과: 간호인력의 제공 시간, 간호사 면허를 가진 인력 확보, 간호인력과 입소노인 간 우호적 관계, 관대한 관리감독 체계가 입소노인의 케어의 질 및 삶의 질에 긍정적인 영향을 미쳤다. 이직률과 agency 간호사 고용 여부에 관해서는 일관적인 연구 결과가 보고되지 않았다. 결론: 노인요양시설의 간호인력은 노인요양시설 입소노인의 케어의 질 및 삶의 질에 영향을 미치는 주요 요인이므로, 의무적인 간호사 인력 배치 수준을 제시하는 정책 마련이 필요하다. 또한 현재 대부분의 연구가 케어의 질을 중점으로 보고하여, 삶의 질에 대한 연구가 추가적으로 수행될 필요가 있다.

• 대한간호학회지
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• 제42권3호
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• pp.351-360
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• 2012

Purpose: The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. Methods: A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. Results: The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Conclusion: Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

• 간호행정학회지
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• 제10권1호
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• pp.1-9
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• 2004

Korean health insurance has adopted preliminary DRG payment system through 8 DRGs from 1997. But present DRG payment system gives economic incentives for hospitals to hire less nurse. This study was attempted to develope DRG adjust index to differentiate DRG price by nurse staffing level for nursing care quality. Method: We analyzed inpatient care cost by medical institute and developed DRG adjust index to differentiate DRG price by nurse staffing level. Results: Among same medical institute, inpatient care cost are very different according to hospital's nurse staffing level. In the case of casarean section, inpatient care cost of the 1st grade general hospital are more expensive 85,732won than the 6th grade hospital. The cost difference are 8.24% of total casarean section DRG price and 16.48% of DTG variable price. We developed DRG adjust index-a to apply DRG variable price and index-b to apply DRG total price for compensation cost difference of hospitals. Conclusions: DRG price adjust index will give economic incentive for hospitals to hire more nurse and improve nursing care quality.

• 임상간호연구
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• 제29권3호
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• pp.312-326
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• 2023

Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results: Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. Conclusion: The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.

• 간호행정학회지
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• 제23권2호
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• pp.211-222
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• 2017

Purpose: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. Methods: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. Results: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. Conclusion: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

• 간호행정학회지
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• 제17권3호
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• pp.327-335
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• 2011

Purpose: The objective of this study was to analyze the effects of medical staffing level as bed-to-medical staff ratio on patient outcomes as length of stay (LOS) among hospitals in Korea. Methods: Two hundred and fifty one hospitals participated in the study between January and March 2008. Data for the study was requested by an electronic data interchange from the Health Insurance Review Agency in 2008. In data analysis, SPSS WIN 15.0 program was utilized for descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression. Results: The mean score for length of stay was 13.6 days. The mean of operating bed-to-nurse ratio was 7.93:1. The predicting factors for LOS were bed-to-nurse's aide ratio, bed-to doctor's ratio, severely ill patient rate, and hospital type. These factors explained 28.9% of the variance in patient outcomes. Conclusion: This study results indicate that the relationship between medical staffing level and patient outcomes is important in the improvement of the quality of patient care. Thus, improvements in the quality of the nurse practice environment could improve patient outcomes for hospitalized patients.

• 임상간호연구
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• 제16권3호
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• pp.99-109
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• 2010

Purpose: This study was aimed to examine changes of hospital nurse staffing by hospital characteristics during 2008-2010. Methods: The study sample included 44 tertiary hospitals, 226 general hospitals, and 532 non-general hospitals that were operating during 2008-2010. Grade of nursing management fee was categorized from Grade 1(highest) to 6 (lowest) in tertiary hospitals, l or Grade 7 in general hospitals and non-general hospitals based on the nurse-to-bed ratio. For data analysis, ${\chi}^2$ and GEE were conducted. Results: For three years, the number of tertiary hospitals below Grade 2 were increased from 8 to 12, the number of those above Grade 4 were decreased from 15 to 6. The number of general hospitals above Grade 6 decreased from 123 to 86. Tertiary hospitals and general hospitals had more possibilities to improve nurse staffing grade than general hospital (OR 79.69, 95% CI 50.77~125.09, OR 11.25, 95% CI 8.15~15.53, respectively). Greater likelihood of improvement in grade of nursing management fee was found in university hospital or hospitals with 300 or more beds than other types of hospitals. Conclusion: Differentiating nurse staffing system by hospital type and increasing financial incentives according to the grades are needed to improve hospital nurse staffing.

• 성인간호학회지
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• 제28권3호
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• pp.256-265
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• 2016

Purpose: This study examined differences in nursing care activity, work performance outcomes, and job satisfaction associated with upgrading nurse staffing of a nurse-to-patients ratio. Methods: Descriptive design was used in this study. In total, 148 medical and surgical nurses were recruited from one university hospital. Three instruments were used for data collection: Scale of Nursing Care Activity, Nurses' Work Performance Outcome Measurement Scale and Nurses' Job Satisfaction Scale. Data were analyzed by using descriptive statistics, t-test, ANOVA, and paired t-test. Results: There were significant differences in nursing care activity (t=-5.06, p<.001), in work performance outcomes (t=-5.46, p<.001) and in job satisfaction (t=4.61, p<.001) when the grading for the nursing staff was changed from three to two indicating increasing number of nurses. Conclusion: The findings from this study showed that there were more nursing care activities, better work performance outcomes, and higher job satisfaction when numbers of nurses were increased. The changes in the scale to evaluate nursing staff influence nursing activities, work performance and job satisfaction.