Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply

Blegen, Mary A.; Vaughn, Thomas; Vojir, Carol P.

doi:10.1111/j.1475-6773.2007.00749.x

Cited by 49 publications

(39 citation statements)

References 29 publications

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“…Four of six studies found that higher nurse staffing levels were significantly associated with shorter length of hospital stay or reduced rates of extended hospital stays (Blegen et al, 2008, Frith et al, 2010, Spetz et al, 2013). …”

Section: Other Outcomesmentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

228

216

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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Section: Other Outcomesmentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

228

216

View full text Add to dashboard Cite

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“…Market-level workforce characteristics could affect the regional supply of nursing staff (Blegen, Vaughn, and Vojir 2008), which in turn could affect nursing costs. We defined market area as the health service area (HSA) or the primary metropolitan statistical area (PMSA) in which a VAMC was located.…”

Section: Variable Definitionmentioning

confidence: 99%

Line Authority for Nurse Staffing and Costs for Acute Inpatient Care

Liu

Sharp

Sales³

et al. 2009

INQUIRY

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There is little empirical evidence evaluating the effects of recent, widespread changes in nurse executive roles and nursing management structures on the costs of patient care. This retrospective cross-sectional study examined the relationship between line authority for nurse staffing and patient care costs (total, nursing, and non-nursing cost) using data from 124 Department of Veterans Affairs (VA) medical centers. After controlling for patient, facility, and market characteristics, nursing line authority was significantly associated with lower nursing cost per admission. Our results provide some evidence that a reduction in nursing line authority may adversely impact nursing costs.

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“…www.kan.or.kr (Bhaskar, Manning, & To, 2002;Greene & Nordhaus-Bike, 1998;Yett, 1966) 선행 연구 결과에 의하면 노동시장의 구조적 특성 이외에도 병원조 직의 특성 (Blegen, Vaughn, & Vojir, 2008;Kim, June, & Cho, 2005;Mullner, Beyers, Levy, Byre, & Mallin, 1983;, 환자의 특성 (Blegen, Goode, & Reed, 1998;Brewer & Frazier, 1998;Hodge et al, 2004), 지역 특성 등의 다양한 요 인들이 간호사 수요에 영향을 미치는 것으로 보고되고 있다 (Bloom, Alexander, & Nuchols, 1997;Grumbach et al, 2001;Robinson, 1988;Seago et al). 따라서 본 연구에서는 지역별 간호사 노동시장의 구조 적 특성을 분석하고 이를 통해 도출된 노동시장 특성 변수들이 병 원의 간호사 확보수준에 미치는 영향을 파악하였다.…”

unclassified

“…(Miller, 1982). (Blegen et al, 2008;Kim et al, 2005;Mullner et al, 1983;Seago et al, 2001). 또한 병원에 입원하는 환자의 특성으로 급성기 환자들 이 많을수록 또는 환자 중증도가 높아질수록 간호사 확보수준이 더 많은 것으로 보고하고 있다 (Blegen et al, 1998;Blegen et al, 2008;Brewer & Frazier, 1998;Hodge et al, 2004;Seago et al).…”

unclassified

“…또한 병원에 입원하는 환자의 특성으로 급성기 환자들 이 많을수록 또는 환자 중증도가 높아질수록 간호사 확보수준이 더 많은 것으로 보고하고 있다 (Blegen et al, 1998;Blegen et al, 2008;Brewer & Frazier, 1998;Hodge et al, 2004;Seago et al). 연구 결과 (Blegen et al, 1998;Blegen et al, 2008;Brewer & Frazier, 1998;Hodge et al, 2004;Seago et al, 2001). …”

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Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels

2013

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연구 배경보건의료의Hospital 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.

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Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply

Cited by 49 publications

References 29 publications

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Line Authority for Nurse Staffing and Costs for Acute Inpatient Care

Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels

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