title: Patient- and ward-level determinants of nursing time in nursing facilities.
abstract: OBJECTIVE
  To explore the patient- and ward-level determinants of wage-adjusted nursing time in long-term care wards for the elderly with a view to improving efficiency of the use of labour resources.
  
  
  METHODS
  The wage-adjusted nursing time given to patients was obtained from a time measurement study. Patient characteristics were based on the Minimum Data Set 2.0 of the Resident Assessment Instrument for nursing homes. Ordinary least-squares regression analysis and multilevel modelling were used to disentangle the effect of patient- and ward-level factors on nursing time.
  
  
  RESULTS
  A significant difference in wage-adjusted nursing time between wards was detected, which was partly explained by characteristics of patients in wards. The combination of patients' physical functioning and cognition and the Resource Utilization Groups RUG-III/22 resource use classification explained 20-25% of patients' nursing time over a 24-hour period. Variables related to the operational environment of the ward did not explain differences in wage-adjusted nursing time once the patient profile of the ward had been controlled for. The results also showed notable unmeasured patient and ward level effects, inefficiency and randomness in the allocation of nursing time.
  
  
  CONCLUSIONS
  By improving the allocation and use of labour resources, the substantial variation in nursing time between wards could be diminished. Managers should allocate their staff primarily according to patients' resource needs.
authors.affiliation: Centre for Health Economics (CHESS), National Research and Development Centre for Welfare and Health (STAKES), Finland. juha.haine@stakes.fi
authors.forename: Juha
authors.initials: J
authors.lastname: Laine
authors.forename: Anja
authors.initials: A
authors.lastname: Noro
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D019985:Benchmarking; D017598:Efficiency, Organizational; D005387:Finland; D006801:Humans; D009732:Nursing Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000458:organization & administration*; D005791:Patient Care; D012456:Salaries and Fringe Benefits; D013997:Time Factors