• 간호행정학회지
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• 제6권1호
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• pp.147-159
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• 2000

This paper studied the factors that influence on RN staffing level in the 43 Specialized general hospitals. Market structure was analysed using the monopsony model. The degree of competition was estimated by Herfindal Index and market was defined as Great medical zone. As the result of the estimation, in the more competitive hospital market hospitals employed the higher level of RN staffing, so monopsony model was supported. Hospitals with above 1001bed employed more RN than hospitals with below 700bed did. Hospital type, hospital union and the number of medical doctor did not affect the level of RN staffing. There was positive correlation between the level of RN staffing and the number of nurse's aid. The structure of RN market in Specified general hospitals was proved monopsony market, it seems that government regulation will be needed to improve social efficiency and equity.

• 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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• 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.

• 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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• 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.

• 대한간호학회지
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• 제54권2호
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• pp.237-249
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• 2024

Purpose: This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. Methods: The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. Results: The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. Conclusion: These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

• Journal of Preventive Medicine and Public Health
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• 제47권5호
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• pp.258-265
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• 2014

Objectives: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.

• 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.

• 간호행정학회지
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• 제19권5호
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• pp.565-577
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• 2013

Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

• 간호행정학회지
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• 제13권1호
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• pp.98-108
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• 2007

Purpose: The objective of this research was to explore the levels of patient satisfaction and job satisfaction according to the level of nurse manpower, in order to provide effective management for nurses. Methods: The research was conducted from November 1 to December 30, 2006, with a survey of 310 nurses and 240 patients at eight tertiary hospitals in Seoul. Data were collected according to the level of nurse manpower from the first (a nurse vs. patient ratio of below 2.0) to the sixth (a ratio of over 4.0) rank. The survey tools were used Park-Yoon's job satisfaction (1992) and Wandelt and Ager (1974)'s patient satisfaction. The acquired data were analyzed with SPSS $PC^+$ 12.0 program using descriptive methods, ${\chi}^2$ test, ANCOVA, and Scheffe. Results: Overall job satisfaction of nurses showed 3.10 and patient satisfaction of patients showed 4.15. Analysis based on the level of nurse manpower showed that hospitals of first and second rank had higher scores than those of lower rank for nurse's job satisfaction and patient satisfaction. Conclusion: Hospitals with a higher level of nurse manpower showed higher score of nurse's job satisfaction and patient satisfaction.