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Factors Related to Nurse Staffing Levels in Tertiary and General Hospitals

  • Kim Yun Mi;June Kyung Ja;Cho Sung-Hyun
    • Journal of Korean Academy of Nursing
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    • v.35 no.8
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    • pp.1493-1499
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    • 2005
  • Background. Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. Purpose. To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. Methods. A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. Results. None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. Conclusions. The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.

A Study of the Job Satisfaction of Clinical Nurses Related to Nurse Staffing (간호등급별 병원 간호사 직무만족 조사)

  • Kim, Jong-Gyeong;Park, Seong-Ae
    • Journal of Korean Academy of Nursing Administration
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    • v.9 no.4
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    • pp.529-539
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    • 2003
  • Purpose : The objective of this research is to explore the job satisfaction of clinical nurses by the rank of nurse staffing in order to provide effective management for nurses. Method : The research has been conducted on three hundred twenty nurses working at tertiary eight hospitals which were from 2nd rank of nurse staffing to 5th. rank of nurse staffing in Seoul, from August 1 to September 30 of 2003, through survey. For the experimental tools, used Park-Yoon's job satisfaction for nurses(1992) which was modified Stamp's job satisfaction test(1978). The acquired data were analyzed through SPSS program using descriptive method, $x^2$-test, ANCOVA, and LSD. Results : Overall job satisfaction of nurses showed fairly high level of 3.17; in the order of high score, 3.84 for interaction, 3.00 for autonomy, 2.63 for administration. Analysis based of the rank of nurse staffing showed that hospitals of 2nd rank and 3rd. rank of nurse staffing which were higher ratio of patient vs nurse were more satisfied with nurses' job satisfaction than other nurses who were 4th. rank and 5th. rank of nurse staffing. Conclusion : The result of this study revealed that hospital which was higher the rank of nurse staffing was more influenced of nurses' job satisfaction and especially interaction, administration and autonomy which were sub-category of job satisfaction were different among the ranks of nurse staffing.

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Competency of Nursing Performance and Job Satisfaction of Operating Room Nurse by Type of Nurse Staffing (간호인력배치유형에 따른 수술실 간호사의 업무수행능력 및 직무만족)

  • Ahn, Young-Mi;Park, Chai-Soon
    • Korean Journal of Women Health Nursing
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    • v.11 no.2
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    • pp.169-175
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    • 2005
  • Purpose: This study was designed to investigate the relationships of the types of nurse staffing, the competency of nursing performance and job satisfaction by analyzing the types of nurse staffing in operating room. Method: The subjects were 472 nurses who work in operating room. The instruments used in this study were three tools: competency of nursing performance, job satisfaction and type of nurse staffing. Result: Type 4 was most in the type of nurse staffing of the subjects. According to the type of nurse staffing, the competency of nursing performance was significantly different. There was significant difference in the competency of nursing performance according to age, marital status, bachelor, employ, position, and career, and job satisfaction according to age, position, and career. In opinion about the ideal type of nurse staffing, type 2 was most regardless of career. Conclusion: Type 4 which has lower competency of nursing performance was adopted in many hospitals now but, type 2 which has highest competency of nursing performance was selected by many nurses as the best one. So, it should be considered the type of nurse staffing of in operating room and change it.

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Changes in Nurse Staffing Grades in General Wards and Adult and Neonatal Intensive Care Units (의료기관의 일반병동, 성인 중환자실, 신생아 중환자실의 간호등급 변화)

  • Hong, Kyung Jin;Cho, Sung-Hyun
    • Journal of Korean Clinical Nursing Research
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    • v.23 no.1
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    • pp.64-72
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    • 2017
  • Purpose: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. Methods: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. Results: The staffing grade for the general wards improved during 2008-2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. Conclusion: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing.

The Effects of Institutional and Market Factors on Nurse Staffing in Acute Care Hospitals (의료기관과 시장특성이 간호사 확보수준에 미치는 영향)

  • Kim, Yun-Mi;Cho, Sung-Hyun;Jun, Kyung-Ja;Go, Su-Kyung
    • Health Policy and Management
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    • v.17 no.2
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    • pp.68-90
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    • 2007
  • Nurse staffing level is an important factor that influences the quality of health service and patient outcomes. This study was carried out to examine the current state of acute hospital nurse staffing and find out factors that affect the nurse staffing level. Nurse staffing of individual hospitals was measured using the number of registered nurses per 100 beds. Descriptive and multiple regression analyses were conducted using 592 acute care hospitals' data. Regression model included structure factors such as referral level, ownership, medical and general staffing, and financial outcome factors such as occupancy rate, inpatient and outpatient revenues. Market characteristics included strength of competition, supply of nurses, and income and health status level of consumers. The average number of nurses per 100 beds was 28 and showed a great variation according to the referral level. Regression model explained this variation as much as 76.87%. Hospital structure variables which affecting the hospital nurse staffing level positively were ICU bed ratio, the staffing level of specialist, training doctor and employees except doctor and nursing personnel, while the negative factor was nurse aid staffing level. General hospitals employed more nurses than hospitals. Among outcome characteristics, occupancy rate and the amount of health insurance inpatient revenue affected positively on the hospital nurse staffing level. The more supply of the new nurse and the higher consumer income and health status in the medical service markets, the more nurses were employed by the medical institutes. According to the study result, hospitals employed more nurses when they had more financial incentive by increasing nurses. This means appropriate hospital incentive policy and regulation policy, which hospital violate nurse staffing level have to pay penality, should be needed. Clarifying job description between nurses and nurse aids and the reentry program for unemployed experienced nurses will be helpful to increase nurse staffing level.

Development of the DRG Fee Adjustment Mechanism Reflecting Nurse Staffing Grades (간호관리료 차등제를 반영한 DRG수가 조정기전 개발)

  • Kim, Yunmi;Kim, Se Young;Kim, Jiyun
    • Journal of Korean Clinical Nursing Research
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    • v.19 no.3
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    • pp.321-332
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    • 2013
  • Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

Nurse Staffing Level Relating Factors of the General Nursing Units, ICU, ER and OR in Acute General Hospitals (종합병원의 일반병동, 중환자실, 응급실, 수술장간호사 확보수준 관련 요인)

  • Kim, Yun-Mi
    • Journal of Korean Academy of Nursing Administration
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    • v.14 no.4
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    • pp.404-412
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    • 2008
  • Purpose: To analyse hospital nurse staffing level of the general nursing unit, ICU, ER and OR in general hospitals. Method: The study sample was 105 acute general hospitals which had reported the bed size and number of nurses by the nursing units. Number of bed per nurse was analysed by the hospital characteristics and the staffing levels of the doctors and the nursing assistant personnels using t-test or ANOVA and Pearson's correlation. Results: Number of bed per nurse was 3.86 in general nursing units and 0.95 in ICU. Tertiary hospitals employed more nurses in general nursing units and ICU than general hospitals. Hospitals located in Seoul and public hospitals employed more ICU nurses. OR nurse staffing level was higher in academic hospitals. Hospital size was positively correlated with nurse staffing level of the general nursing unit, ICU, ER and OR respectively. Total nurse staffing level of the hospital was positively correlated with doctor and nursing assistant personnels staffing levels. Conclusion : Differentiated nursing fee schedule was needed to implement in ER or OR. Regulation policy should be needed for the hospitals which violated hospital nurse staffing level of the law.

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Policy Implications of Nurse Staffing Legislation (간호사 배치기준에 대한 정책적 함의)

  • You, Sun-Ju
    • The Journal of the Korea Contents Association
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    • v.13 no.6
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    • pp.380-389
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    • 2013
  • The nurse staffing level in the acute care hospitals affects patient safety and performance, and the nurse staffing legislation can be an important tool to guarantee the minimum nurse staffing. In Korea, although the medical law suggests the nurse staffing standards, it is necessary to revise the medical law for quality of nursing care and patient safety. Firstly, the nurse staffing standards in the current medical law enacted in 1962 needs to be revised to reflect changes in health care environment. Secondly, legal nurse staffing standards in the medical law are the minimum nurse staffing that medical institutions should comply with and thus must be managed so that all medical institutions should abide by them. Thirdly, the nurse staffing standards should apply on the basis of RN-to-patient ratios per shift in order to help patients understanding and ensure the easy management. Fourthly, the information of nursing staff level by the nursing unit and nursing shift in hospitals shall be released.

Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients (의료기관 간호사 확보수준이 수술환자의 사망, 폐렴, 패혈증, 요로감염에 미치는 영향)

  • Kim, Yunmi;Cho, Sung-Hyun;June, Kyung Ja;Shin, Soon Ae;Kim, Jiyun
    • Journal of Korean Academy of Nursing
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    • v.42 no.5
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    • pp.719-729
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    • 2012
  • Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels (간호사 노동시장의 구조분석 및 병원 간호사 확보수준의 결정요인)

  • Park, Bohyun;Seo, Sukyung;Lee, Taejin
    • Journal of Korean Academy of Nursing
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    • v.43 no.1
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    • pp.39-49
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    • 2013
  • Purpose: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Methods: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. Results: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. Conclusion: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.