• 보건행정학회지
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• 제17권2호
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• pp.68-90
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• 2007

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.

• 간호행정학회지
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• 제14권4호
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• pp.404-412
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• 2008

Purpose: To analyse hospital nurse staffing level of the general nursing unit, ICU, ER and OR in general hospitals. Method: The study sample was 105 acute general hospitals which had reported the bed size and number of nurses by the nursing units. Number of bed per nurse was analysed by the hospital characteristics and the staffing levels of the doctors and the nursing assistant personnels using t-test or ANOVA and Pearson's correlation. Results: Number of bed per nurse was 3.86 in general nursing units and 0.95 in ICU. Tertiary hospitals employed more nurses in general nursing units and ICU than general hospitals. Hospitals located in Seoul and public hospitals employed more ICU nurses. OR nurse staffing level was higher in academic hospitals. Hospital size was positively correlated with nurse staffing level of the general nursing unit, ICU, ER and OR respectively. Total nurse staffing level of the hospital was positively correlated with doctor and nursing assistant personnels staffing levels. Conclusion : Differentiated nursing fee schedule was needed to implement in ER or OR. Regulation policy should be needed for the hospitals which violated hospital nurse staffing level of the law.

• 대한간호학회지
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• 제42권5호
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• pp.719-729
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• 2012

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.

• 근관절건강학회지
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• 제29권1호
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• pp.41-49
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• 2022

Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes in intensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and their outcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. The observation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: The mortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval, 1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitals with a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidence interval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95% confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant of healthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are therefore required to enhance patient outcomes.

• 임상간호연구
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• 제19권3호
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• pp.321-332
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• 2013

Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

• 한국콘텐츠학회논문지
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• 제13권6호
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• pp.380-389
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• 2013

급성기 병원의 간호사 배치수준은 환자안전 및 성과에 영향을 미치며, 간호사 배치기준의 법제화는 환자안전에 필요한 최소 인원을 보장하는 중요한 수단이 될 수 있다. 우리나라는 의료법에 간호사 정원기준을 제시하고 있으나, 환자안전 보장 및 간호의 질 향상을 위해서 다음의 몇 가지 사항에 대한 개선이 필요하다. 첫째 1962년 제정된 현행 의료법의 간호사 정원기준은 보건의료환경 변화에 따라 적정성에 대한 재검토가 필요하다. 둘째 의료법의 간호사 정원은 의료기관이 준수하여야할 최소 인원으로 모든 의료기관이 준수하도록 관리되어야 한다. 셋째, 간호사 배치기준은 환자의 이해를 돕고, 관리가 용이하도록 근무조당 입원환자수 대 간호사 수를 기준으로 하도록 한다. 넷째, 병원 간호단위별 근무조별 간호인력 배치정보를 공개하여야 한다.

• 재활간호학회지
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• 제14권1호
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• pp.62-69
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• 2011

Purpose: The study assessed whether nurse staffing was associated with 3 nursing sensitive outcomes used in intensive care unit (ICU) nursing care plans. Methods: This study was a retrospective and descriptive study using clinical data extracted from the data warehouse of a large acute care hospital in the Midwest. One-way analysis of variance was used to analyze the records of 578 ICU patients admitted from March 25 to May 31, 2010. Results: 79 Nursing Outcomes Classification (NOC) outcomes were used in the nursing care plans. The 3 most commonly used NOC outcomes (Pain Level, Infection Severity, and Tissue Integrity: Skin and Mucous Membranes) were analyzed to determine their relationship to nurse staffing. As a nurse staffing ratio, the skill mix of nursing caregivers ranged from 0.74 to 1 with an average of 0.90. This skill mix of nursing caregivers significantly differed among the changes in Infection Severity scores. However, the mean difference was only 0.02. Conclusion: The results did not support that greater nurse staffing was associated with better outcomes. More research is still needed to determine the usefulness of Pain Level, Infection Severity, and Tissue Integrity: Skin and Mucous Membranes in evaluating the impact of nurse staffing.

• 대한간호학회지
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• 제43권1호
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• pp.39-49
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• 2013

Purpose: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Methods: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. Results: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. Conclusion: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

• 간호행정학회지
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• 제21권2호
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• pp.174-183
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• 2015

Purpose: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

• 간호행정학회지
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• 제9권4호
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• pp.529-539
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• 2003

Purpose : The objective of this research is to explore the job satisfaction of clinical nurses by the rank of nurse staffing in order to provide effective management for nurses. Method : The research has been conducted on three hundred twenty nurses working at tertiary eight hospitals which were from 2nd rank of nurse staffing to 5th. rank of nurse staffing in Seoul, from August 1 to September 30 of 2003, through survey. For the experimental tools, used Park-Yoon's job satisfaction for nurses(1992) which was modified Stamp's job satisfaction test(1978). The acquired data were analyzed through SPSS program using descriptive method, $x^2$-test, ANCOVA, and LSD. Results : Overall job satisfaction of nurses showed fairly high level of 3.17; in the order of high score, 3.84 for interaction, 3.00 for autonomy, 2.63 for administration. Analysis based of the rank of nurse staffing showed that hospitals of 2nd rank and 3rd. rank of nurse staffing which were higher ratio of patient vs nurse were more satisfied with nurses' job satisfaction than other nurses who were 4th. rank and 5th. rank of nurse staffing. Conclusion : The result of this study revealed that hospital which was higher the rank of nurse staffing was more influenced of nurses' job satisfaction and especially interaction, administration and autonomy which were sub-category of job satisfaction were different among the ranks of nurse staffing.