title: The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets.
abstract: BACKGROUND
  Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets.
  
  
  OBJECTIVE
  In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida.
  
  
  METHODS
  By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals.
  
  
  RESULTS
  Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets.
  
  
  CONCLUSIONS
  Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.
authors.affiliation: Department of Health Services Research, Management and Policy, University of Florida, Gainesville, USA. gatoreng@ufl.edu
authors.forename: Damian
authors.initials: D
authors.lastname: Everhart
authors.forename: Donna
authors.initials: D
authors.lastname: Neff
authors.forename: Mona
authors.initials: M
authors.lastname: Al-Amin
authors.forename: June
authors.initials: J
authors.lastname: Nogle
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
mesh_terms: D004465:Economic Competition; D004469:Economics, Hospital; D017598:Efficiency, Organizational / Q000191:economics; D005431:Florida; D006761:Hospitals / Q000592:standards; D006801:Humans; D009732:Nursing Care / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000191:economics / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics; D011795:Surveys and Questionnaires; D000078329:Workforce