title: An Examination of Hospital Nurse Staffing and Patient Experience with Care: Differences between Cross-Sectional and Longitudinal Estimates.
abstract: OBJECTIVE
  To study the association between hospital nurse staffing and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
  
  
  METHODS
  State hospital financial and utilization reports, Healthcare Cost and Utilization Project State Inpatient Databases, HCAHPS survey, and American Hospital Association Annual Survey of Hospitals.
  
  
  METHODS
  Retrospective study using cross-sectional and longitudinal models to estimate the effect of nurse staffing levels and skill mix on seven HCAHPS measures.
  
  
  METHODS
  Hospital-level data measuring nurse staffing, patient experience, and hospital characteristics from 2009 to 2011 for 341 hospitals (977 hospital years) in California, Maryland, and Nevada.
  
  
  RESULTS
  Nurse staffing level (i.e., number of licensed practical nurses and registered nurses per 1,000 inpatient days) was significantly and positively associated with all seven HCAHPS measures in cross-sectional models and three of seven measures in longitudinal models. Nursing skill mix (i.e., percentage of all staff who are registered nurses) was significantly and negatively associated with scores on one measure in cross-sectional models and none in longitudinal models.
  
  
  CONCLUSIONS
  After controlling for unobserved hospital characteristics, the positive influences of increased nurse staffing levels and skill mix were relatively small in size and limited to a few measures of patients' inpatient experience.
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Grant R
authors.initials: GR
authors.lastname: Martsolf
authors.affiliation: Health Outcomes Research, Truven Health Analytics, Ann Arbor, MI.
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.affiliation: Health Outcomes Research, Truven Health Analytics, Santa Barbara, CA.
authors.forename: Richele
authors.initials: R
authors.lastname: Benevent
authors.affiliation: Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: H Joanna
authors.initials: HJ
authors.lastname: Jiang
authors.affiliation: Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Carol
authors.identifier: http://orcid.org/0000-0003-3440-3193
authors.initials: C
authors.lastname: Stocks
authors.affiliation: Health Research Division, Mathematica Policy Research, Ann Arbor, MI.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Ehrlich
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kandrack
authors.affiliation: Center for Interdisciplinary Health Workforce Studies at Montana State University, Bozeman, MT.
authors.forename: David I
authors.initials: DI
authors.lastname: Auerbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009505:Nevada; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Patient care; nurse staffing; nursing care; patient satisfaction