Variations in Nurse Staffing in Adult and Neonatal Intensive Care Units

의료기관 및 중환자실 특성에 따른 간호사 배치수준

  • Cho Sung-Hyun (Department of Nursing, Hanyang University) ;
  • Hwang Jeong-Hae (Center for Quality Evaluation and Improvement, Health Insurance Review Agency) ;
  • Kim Yun-Mi (Department of Nursing, Seoul Health College) ;
  • Kim Jae-Sun (Center for Quality Evaluation and Improvement, Health Insurance Review Agency)
  • 조성현 (한양대학교 간호학과) ;
  • 황정해 (건강보험심사평가원 평가실) ;
  • 김윤미 (서울보건대학 간호과) ;
  • 김재선 (건강보험심사평가원 평가실)
  • Published : 2006.08.01

Abstract

Purpose: This study was done to analyze variations in unit staffing and recommend policies to improve nursing staffing levels in intensive care units (ICUS). Method: A cross-sectional study design was used, employing survey data from the Health Insurance Review Agency conducted from June-July, 2003. Unitstaffing was measured using two indicators; bed-to-nurse (B/N) ratio (number of beds per nurse), and patient-to-nurse (P/N) ratio (number of average daily patients per nurse). Staffing levels were compared according to hospital and ICU characteristics. Result: A total of 414 institutions were operating 569 adult and 86 neonatal ICUs. Tertiary hospitals (n=42) had the lowest mean B/N (0.82) and P/N (0.76) ratios in adult ICUs, followed by general hospitals (B/N: 1.34, P/N: 0.97). Those ratios indicated that a nurse took care of 3 to 5 patients per shift. Neonatal ICUs had worse staffing and had greater variations in stafnng ratios than adult ICUs. About 17% of adult and 26% of neonatal ICUs were staffed only by adjunct nurses who had responsibility for a general ward as well as the ICU Conclusion: Stratification of nurse staffing levels and differentiation of ICU utilization fees based on staffing grades are recommended as a policy tool to improve nurse staffing in ICUs.

Keywords

References

  1. Angus, D., & Black, N. (2004). Improving care of the critically ill : Institutional and health-care system approaches. Lancet, 363, 1314-1320 https://doi.org/10.1016/S0140-6736(04)16007-8
  2. Beckmann, U., Baldwin, I., Durie, M., Morrison, A., & Shaw, L. (1998). Problems associated with nursing staff shortage : An analysis of the first 3600 incident reports submitted to the Australian Incident Monitoring Study (AIMS-ICU). Anaesth Intensive Care, 26, 396-400
  3. Coffman, J. M., Seago, J. A., & Spetz, J. (2002). Minimum nurse-to-patient ratios in acute care hospitals in California. Health Aff, 21, 53-64 https://doi.org/10.1377/hlthaff.21.5.53
  4. Differentiated nursing fees requested by 178 institutions. (2005, July 21). The Korean Nurses Association News, p.1
  5. Health Insurance Review Agency (2004). Evaluation of appropriateness of intensive care unit utilization. Health Insurance Review Agency
  6. Health Insurance Review Agency (2005). A study on development of criteria for categorizing ICUs and improvement of payment system of ICUs in Korea. Health Insurance Review Agency
  7. Hodge, M. B., Romano, P. S., Harvey, D., Samuels, S. J., Olson, V. A., Sauve, M. J., & Kravitz, R. L. (2004). Licensed caregiver characteristics and staffing in California acute care hospital units. J Nurs Adm, 34, 125-133 https://doi.org/10.1097/00005110-200403000-00005
  8. International Council of Nurses (2003). ICN Fact Sheet : Nurse : Patient Ratios. Retrieved from the ICN Web site: http://www.icn.ch/matters_rnptratio_print.htm
  9. Jun, E. K. (2000). Nursing time use in a newborn intensive care unit (NICU). J Korean Acad Nurs Adm, 6, 55-81
  10. Kim, K. Y., & Jang, K. S. (2002). The study of critical indicator development for establishing patient classification system in the intensive care unit. J Korean Acad Nurs Adm, 8, 475-488
  11. Lee, K. O., Shin, H. J., Park, H. A., Jeong, H. M., Lee, M. H., Choi, E. H., Lee, J. M., Kim, Y. J., Sim, Y. K., & Park, K. J. (2000). Patient severity classification in a medical ICU using APACHE ill and patient severity classification tool. J Korean Acad Nurs, 30, 1243-1253 https://doi.org/10.4040/jkan.2000.30.5.1243
  12. Moreno, R., & Reis Miranda, D. (1998). Nursing staff in intensive care in Europe : The mismatch between planning and practice. Chest, 113, 752-758 https://doi.org/10.1378/chest.113.3.752
  13. Parish, C. (2002). Minimum effort. Nurs Stand, 16(42), 12-13
  14. Park, J. H., Kim, M. A., Sung, Y. H., Song, K. J., Song, M. S., Sim, W. H., & Lee, Y. S. (2003a). Policy Report on Differentiating Nursing Fees in General and Intensive Care Units. Clinical Nurses Association
  15. Park, J. H., Kim, M. A., Sung, Y. H., Song, K. J., Song, M. S., Sim, W. H., & Lee, Y. S. (2003b). Estimation of Nursing Costs by Nurse Staffing Grades and Patient Classification System in General and Intensive Care Units. Clinical Nurses Association
  16. Pronovost, P. J., Jenckes, M. W., Dorman, T., Garrett, E., Breslow, M. J., Rosenfeld, B. A., Lipsett, P. A., & Bass, E. (1999). Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA, 281, 1310-13171 https://doi.org/10.1001/jama.281.14.1310
  17. Tajimi, K., Shimada, Y., Nishimura, S, & Sirio, C. A. (1994). Japan. New Horizons, 2, 404-412
  18. Tarnow-Mordi, W. O., Hau, C., Warden, A., & Shearer, A. J. (2000). Hospital mortality in relation to staff workload : A 4-year study in an adult intensive-care unit. Lancet, 356, 185-189 https://doi.org/10.1016/S0140-6736(00)02478-8
  19. Thorens, J. B., Kaelin, R. M., Jolliet, P., & Chevrolet, J. C. (1995). Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med, 23, 1807-1815 https://doi.org/10.1097/00003246-199511000-00004
  20. Tucker, J., Parry, G., McCabe, C., Nicolson, P., & Tarnow-Mordi, W. (2002). Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units : a prospective evaluation. Lancet, 359, 99-107 https://doi.org/10.1016/S0140-6736(02)07366-X