The Effects of Nurse Staffing and Skill Mix on In-hospital Mortality in the Hospitals with Different Characteristics

Abstract

Objectives The characteristics of nursing workforce is critically important in achieving quality care in a hospital. However, current hospital industry environment does not allow ample investment in human resource. Therefore, hospital management has to come up with effective ways of investment in nursing resources. This study was conducted with the purpose of providing basic information needed for effective nurse staffing decision in hospitals. The impacts of nurse staffing level in terms of quality and quantity on health outcome were analyzed. Methods Nurse staffing level and in-hospital mortality data of 3,451 hospitals nationwide were analyzed using multiple regression models. Dependent variable of the model was in-hospital mortality and independent variables included number of patient per nurse and percentage of nurse aid in nursing staff. As the control variables, patients characteristics and hospital organizational characteristics were included in the model. Results Number of patients per nurse and proportion of nurse aides in nursing staff showed significant positive effects on in-hospital mortality. The effects were stronger in the hospital group that had relatively lower nurse staffing level. The positive relationship between staffing level and mortality rate was stronger in the hospitals that had higher severity level. Conclusions Health policy should focus on improving minimum standard of nurse staffing level. Also, hospitals should lay nursing staff investment priority on the nursing units that serve high severity patients. Key words: Nurse staffing, Skill mix, In-hospital mortality, Hospital characteristics, Human resources