title: Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels.
abstract: This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs).
  
  
  
  We used 5 years of data (2010-2014) from an operational database maintained by Premier, Inc. that tracks labor hours, hospital units, and facility characteristics.
  
  
  
  We assessed changes over time in the average number of total hours worked by RNs, LPNs, and CNLP, adjusted by total patient days. We then conducted linear regressions to estimate the relationships between nurse and CNLP staffing, controlling for patient acuity, volume, and hospital fixed effects.
  
  
  
  The overall use of CNLP and LPN hours per patient day declined from 2010 to 2014, while RN hours per patient day remained stable. We found no evidence of substitution between CNLP and nurses during the study period: Nurse-related CNLP hours were positively associated with RN hours and not significantly related to LPN hours, holding other factors constant.
  
  
  
  Findings point to the importance of examining where and why CNLP hours per patient day have declined and to understanding of the effects of these changes on outcomes.
authors.affiliation: Mathematica Policy Research Inc, Princeton, NJ.
authors.forename: Suhui
authors.initials: S
authors.lastname: Li
authors.affiliation: George Washington University, the Milken Institute of Public Health, and the Health Workforce Institute, Washington, DC.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pittman
authors.affiliation: George Washington University, the Milken Institute of Public Health, and the Health Workforce Institute, Washington, DC.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Han
authors.affiliation: Premier Research Institute, Premier Inc., Charlotte, NC.
authors.forename: Timothy John
authors.initials: TJ
authors.lastname: Lowe
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data / Q000600:supply & distribution* / Q000639:trends*; D002568:Certification / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005544:Forecasting; D006801:Humans; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution* / Q000639:trends*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data* / Q000639:trends*; D014481:United States
keywords: Health care workforce; clinical nonlicensed personnel; nurse staffing; substitution; unlicensed assistive personnel