Determinants of Registered Nurse Skill Mix & Staffing Level in Korea

간호인력 구성 및 확보수준 결정 요인

  • Cho, Su-Jin (College of Nursing, Seoul National University) ;
  • Kim, Jinhyun (College of Nursing.The Research Institute of Nursing Science, Seoul National University)
  • 조수진 (서울대학교 간호학과) ;
  • 김진현 (서울대학교 간호학과.간호과학연구소)
  • Received : 2013.10.04
  • Accepted : 2013.12.31
  • Published : 2014.01.31


Purpose: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. Methods: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. Results: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. Conclusion: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.


  1. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288, 1987-1993.
  2. Blegen, M. A., Vaughn, T., & Vojir, C. P. (2008). Nurse staffing levels: Impact of organizational characteristics and registered nurse supply. Health Services Research, 43, 154-173.
  3. Bloom, J. R., Alexander, J. A., & Nuchols, B. A. (1997). Nurse staffing patterns and hospital efficiency in the United States. Social Science in Medicine, 44, 147-55. (96)00063-9
  4. Buerhaus, P. I., Donelan, K., DesRoches, C., & Hess, R. (2009). Registered nurses' perceptions of nurse staffing ratios and new hospital payment regulations. Nursing Economics, 27, 372-376.
  5. Cho, S.-H., & Yun, S.-C. (2009). Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data. International Journal of Nursing Study, 46, 1092-1101.
  6. Cho, S.-J., Lee, H., Oh, J.-Y., & Kim, J.-H. (2011). Inpatient outcomes by nurse staffing grade in Korea. Korean Journal of Health Policy & Administration, 21, 195-212.
  7. Feldstein, P. J. (1999). Health care economics (5th ed.). New York: Delmar.
  8. Grumbach, K., Ash, M., Seago, J. A., Spetz, J., & Coffman, J. (2001). Measuring shortages of hospital nurses: How do you know a hospital with a nursing shortage when you see one? Medical Care Research and Review, 58, 387-403.
  9. Hodge, M. B., Romano, P. S., Harvey, D., Samuels, S. J., Olson, V. A., Sauve, M. J., et al. (2004). Licensed caregiver characteristics and staffing in California acute care hospital units. Journal of Nursing Administration, 34 , 125-33.
  10. Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2005). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45, 1195-1204.
  11. Kim, Y. M. (2000). Analysis of the factors that influence on the RN staffing level in the specified general hospitals. Journal of Korean Academy of Nursing Administration, 6, 147-159.
  12. Kim, Y. M., Cho, S.-H., Jun, K. J., & Go, S. K. (2007). The effect of institutional and market factors on nurse staffing in acute care hospitals. Korean Journal of Health Policy & Administration, 17, 68-90.
  13. Kim, Y. M., Jun, K. J., & Cho, S.-H. (2005). Factors related to nurse staffing levels in tertiary and general hospitals. Journal of Korean Academy of Nursing, 35, 1493-1499.
  14. Korean Small & Medium Hospital Association & Korean Health Industry Development Institute. (2008). Research on the actual condition of nurse staffing and nurse staffing grade. Journal of Korean Hospital Association, Mar-Apr , 65-73.
  15. Lankshear, A. J., Sheldon, T. A., & Maynard, A. (2005). Nurse staffing and healthcare outcomes: A systematic review of the international research evidence. Advances in Nursing Science, 28, 163-174.
  16. Lee, S., & Kim, H. (2008). Development of hospital workforce structure for quality improvement. Seoul: Korea Public Service Union.
  17. Lin, L., & Liang, B. A. (2007). Addressing the nursing work environment to promote patient safety. Nursing Forum, 42, 20-30.
  18. Mark, B. A., Salyer, J., & Wan, T. (2000). Market, hospital, and nursing unit characteristics as predictors of nursing unit skill mix: A contextual analysis. Journal of Nursing Administration, 30, 552-60.
  19. Needleman, J. (2008). Is what's good for the patient good for the hospital? Aligning incentive and the business case for nursing. Policy, Politics, & Nursing Practice, 9, 80-87. http://dx.
  20. Newbold, D. (2008). The production economics of nursing: A discussion paper. International Journal of Nursing Studies, 45 , 120-128.
  21. Numata, Y., Schulzer, M., Wal, R., Globerman, J., Semeniuk, P., Balka, E., et al. (2006). Nurse staffing levels and hospital mortality in critical care setting: Literature review and metaanalysis. Journal of Advanced Nursing, 55, 435-448. http://
  22. Park, S.-H. (2003). Analysis of direct nursing activity and patient outcomes related to graded fee of nursing management for inpatient. Journal of Korean Academy of Nursing, 33, 122-129.
  23. Seago, J. A., Spetz, J., & Mitchell, S. (2004). Nurse staffing and hospital ownership in California. Journal of Nursing Administration, 34, 228-37.
  24. You, S.-J., Choi, Y., Kim, H., Park, B., Jang, H., & Park, J. (2006). Development of a inpatient health care service model for job creation. Seoul: Korea Health Industry Development Institute.

Cited by

  1. Nursing outcomes of inpatient on level of nursing staffing in long term care hospitals vol.26, pp.3, 2015,
  2. A causal model for the quality of nursing care in Thailand pp.00208132, 2018,