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Nurse-staffing level and quality of acute care services: Evidence from cross-national panel data analysis in OECD countries.

ABSTRACT: Background:Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed. Objective:To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run. Data:The number of practicing nurses' density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators (HCQI) included 30-day mortality per 100 patients based on acute myocardial infarction (MORTAMIO), hemorrhagic stroke (MORTHSTO) and ischemic stroke (MORTISTO) were collected as a part of ongoing project by OECD.org in panels of 26 OECD countries over 2005-2015 period. Method:Panel data analysis. Results:There were committed relationships from nurse-staffing level to the enhancement of HCQI i.e. 1% increase in nurse-staffing level would reduce the rates of patient mortality based on MORTAMIO, MORTHSTO and MORTISTO by 0.65%, 0.60% and 0.80%, respectively. Furthermore, the role of nurse-staffing level in increasing overall HCQI were simulated at the highest level in Sweden (-3.53), Denmark (-3.31), Canada (-2.59), Netherlands (-2.33), Finland (-2.09), Switzerland (-1.72), Australia (-1.64) and United States (-1.53). Conclusion:A higher proportion of nurses-staffing level is associated with higher quality of acute care services in OECD countries. Also, the nursing characteristics of Sweden, Denmark, Canada, Netherlands, Finland, Switzerland, Australia and United States would be good patterns for other countries to maximize nursing outcomes in the care of patients with acute and life-threatening conditions by reducing the risk of complication, mortality and adverse clinical outcomes.

SUBMITTER: Amiri A

PROVIDER: S-EPMC6608666 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Nurse-staffing level and quality of acute care services: Evidence from cross-national panel data analysis in OECD countries.

Amiri Arshia A Solankallio-Vahteri Tytti T

International journal of nursing sciences 20181205 1

<h4>Background</h4>Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed.<h4>Objective</h4>To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run.<h4>Data</h4>The number of practicing nurses' density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators (HCQI) included 30-day mortality ...[more]

PMID: 31406863

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Project description:ObjectiveThe objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing.MethodsUsing 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors.ResultsCompared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours.ConclusionsWhen we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

Dataset Information

Nurse-staffing level and quality of acute care services: Evidence from cross-national panel data analysis in OECD countries.

Publications

Nurse-staffing level and quality of acute care services: Evidence from cross-national panel data analysis in OECD countries.

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