• Journal of Korean Academy of Nursing Administration
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• v.9 no.4
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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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.4
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• pp.408-417
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• 2017

This study was conducted to examine the influence of the nurse staffing level on the level of in-hospital death and infection in cancer patients who received surgery. Secondary data were used and the subjects of this study were 24,510 patients who received surgery for six types of cancer with a high postoperative mortality rate in the first half of 2012 at 260 hospitals. Simple logistic and GEE multiple logistic regression analyses were used. After adjusting for the patient and hospital characteristics, a greater likelihood of dying was found in the nurse staffing level 2-3 group (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11) and in the level 6-7 group (OR, 3.28; 95% CI, 1.87-5.74) compared to the level 0-1 group. The likelihood of in-hospital infection increased with each additional bed per nurse, being 6.63 times higher (95% CI, 3.00-14.62) in the level 2-3 group, 5.79 times higher (95% CI, 1.88-17.78) in the level 4-5 group, and 8.4 times higher (95% CI, 1.82-38.84) in the level 6-7 group, as compared to the level 0-1 group. A lower nurse staffing level was associated with higher in-hospital death and infection levels. This shows that an appropriate nurse staffing level is associated with superior postoperative cancer patient outcomes. Policies for providing adequate nurse staffing should be maintained for the sake of ensuring improved care quality and patient safety.

• The Journal of the Convergence on Culture Technology
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• v.7 no.2
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• pp.247-259
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• 2021

Purpose: The purpose of this study was to figure out the effect of nurse staffing in nursing home on the quality of care and quality of life of the residents, using Castle & Engberg's conceptual framework. Methods: A total of 31 studies published between 1996 and 2021 were selected from 6 databases, searched for keyword such as "Nurse staffing", "Nursing staff", "Outcome", "Quality of care", "Quality of life", "residents outcomes", "nursing home", "long-term care". By using Castle & Engberg's conceptual framework, systematic review was conducted. Results: More time provided by nursing staff, high level of licensed nurse staffing, good relationship between nursing staff and residents, and generous supervision system have a positive effect on resident outcomes. Conclusion: Establishing regulatory strategies of having mandatory Registered Nurse is needed because nurse staffing in nursing homes was related to resident outcomes. In addition, it is necessary to conduct further research about quality of life beyond quality of care for residents.

• Journal of Korean Academy of Nursing
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• v.42 no.3
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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.

• Journal of Korean Academy of Nursing Administration
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• v.10 no.1
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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.

• Journal of Korean Clinical Nursing Research
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• v.29 no.3
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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.

• Journal of Korean Academy of Nursing Administration
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• v.23 no.2
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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.

• Journal of Korean Academy of Nursing Administration
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• v.17 no.3
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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.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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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.

• Korean Journal of Adult Nursing
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• v.28 no.3
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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.