Patient turnover and nursing staff adequacy.
OBJECTIVE
To assess the relative validity of patient turnover adjustments and the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not.


METHODS
Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system.


METHODS
After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two-patient turnover indices, with and without patient severity adjustments, to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests.


METHODS
Data sets were match merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC, and APDC adjusted for patient turnover and both patient turnover and severity.


RESULTS
Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1995 onward. Unadjusted RN staffing showed a 1 percent decline over the 8-year-period compared with decreases of from 9 to 26 percent after adjustments.


CONCLUSIONS
These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making.
Unruh
Lynn Y
LY
Department of Health Professions College of Health and Public Affairs, University of Central Florida, Orlando, FL 32816, USA.
Fottler
Myron D
MD
D006760:Hospitalization; D006801:Humans; D009736:Nursing Process / Q000458:organization & administration; D009740:Nursing Staff / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D016526:Workload