title: Effect of nurse staffing variation and hospital resource utilization.
abstract: In this study, we examined the effect of variations in nurse staffing levels on the length of stay and medical expenses of patients who underwent hip or knee surgeries. A cross-sectional study was conducted using the National Health Insurance database and hospital surveys from 2010. Patient length of stay and medical expenses by nurse staffing level and skill mix were compared after adjusting for hospital and patient characteristics. Nurse staffing was measured based on staffing grade, the bed-to-registered nurse/nurse aid ratio, the bed-to-nursing personnel ratio, and the RN proportion. Generalized estimation models were used to analyze the associations. Decreased nurse staffing was consistently associated with increased length of stay, regardless of nurse staffing measures. The medical expenses associated with the lowest staffing level were approximately $US 1142.2 more than those associated with the highest staffing level. The study results suggest that maintaining a high nurse staffing level could be a cost-effective strategy for government and insurers, as well as for patients. We propose that policy makers implement more efficient nurse staffing strategies.
authors.affiliation: Department of Nursing, Eulji University, Seongnam, South Korea.
authors.forename: Yunmi
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Nursing, College of Nursing, Dankook University, Cheonan, South Korea.
authors.forename: Seon-Ha
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Benefit Coverage, National Health Insurance Service, Seoul, South Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000592:standards / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000600:supply & distribution; D009728:Nursing Assistants / Q000600:supply & distribution; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000706:statistics & numerical data; D056910:Republic of Korea
keywords: South Korea; hip/knee replacement surgery; length of stay; medical expense; nurse staffing; nurse/patient ratio; policy