• 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.

• Korean Journal of Adult Nursing
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• v.26 no.6
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• pp.642-652
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• 2014

Purpose: The purpose of this study was to compare the role-expectations of gerontological nurse practitioners and performance of gerontological nursing by nurses in long term care hospitals and general hospitals. Methods: Subjects were 200 nurses; 100 nurses from long term care hospitals where as 100 nurses from general hospitals. The subjects completed a questionnaire on general characteristics, role-expectations of gerontological nurse practitioners, and performance of gerontological nursing by nurses. Data were collected from February to March 2013 and analyzed using SPSS/WIN 18.0 version program in order to perform descriptive statistics, independent t-test, and one-way ANOVA. Results: Results indicated that there were significant differences in the role-expectations of gerontological nurse practitioners and performance of gerontological nursing between nurses from long term care hospitals and those from general hospitals. Conclusion: Nurses in general hospitals showed significantly higher role expectations than nurses in long term care hospitals. Therefore it is necessary to spread the knowledge on the roles of gerontological nurse practitioners and the nurse practitioners system to nurses in long term care hospitals.

• 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.

• 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.

• Asian Journal for Public Opinion Research
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• v.4 no.2
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• pp.88-107
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• 2017

Background: Adolescent mothers may find the transition to motherhood to be Aim: The aim of this study was to investigate the viewpoints of nurse managers and directors of nursing services in community hospitals regarding the essential competencies of head nurses. Methods: A qualitative descriptive design was used to investigate the perspective of nurse managers and directors of nursing services about essential competencies of nurse managers in community hospitals. A total of ten participants (four directors of nursing services and six nurse managers) were interviewed. Findings: Nurse managers and directors of nursing services identified leadership, management, communication, professional ethics, and policy and healthcare environment as the essential competencies for their positions in community hospitals. Conclusions: These findings can be used by executives of community hospitals and nursing institutes to plan for competency development for nurse managers. They should be included in nursing administration programs.

• 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.

• Journal of Korean Academy of Nursing Administration
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• v.18 no.4
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• pp.414-423
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• 2012

Purpose: The purpose of this study was to investigate the impact of the unit-level nurse practice environment on nurse turnover intention in the small and medium sized hospitals. Methods: A cross-sectional study was conducted using a questionnaire survey with 308 nurses in 38 nursing units of 6 small and medium sized hospitals, having over 200 beds and under 300 beds and located in B metropolitan city. Data were collected from July 20 to August 10, 2011. Data were analyzed using hierarchical multiple regression. Results: The mean turnover intention in nurses of small and medium sized hospitals was $3.52{\pm}0.53$. Factors affecting turnover intention in the nurses included age, work unit, monthly income, number of night-duties, work hours per day and unit-level nurse practice environment. The unit-level nurse practice environment accounted for 15% of turnover intention when other variables were controlled. Conclusion: The results of the study indicate that nurse turnover intention is associated with the nurse practice environment at the unit level. Small and medium sized hospitals can improve nurse retention and lower turnover intention by changing the nurse practice environment of unit, such as creating better support services and nurse participation in hospital affairs.

• Journal of Korean Academy of Nursing Administration
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• v.14 no.2
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• pp.167-175
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• 2008

Purpose: To examine the changes in nurse staffing in hospitals after implementing the policy of differentiating inpatient nursing fees by staffing grades. Method: The study sample included 43 tertiary hospitals, 185 general hospitals, and 282 non-general hospitals that were operating in both 1999 and 2008. Nurse staffing grade was categorized from Grade 1 (highest) to 6 (lowest) in 1999 or Grade 7 in 2008, based on the nurse-to-bed ratio. Results: Tertiary hospitals at Grade 3 and Grade 4 accounted for 49% and 35%, respectively, in 2008, whereas 63% were Grade 6 in 1999. General hospitals at Grade 6 decreased from 87% to 48%. In non-general hospitals, little change was found in the staffing distribution, in that 92% still remained in Grade 6 or 7 in 2008. Forty tertiary hospitals (93%) and 45% of general hospitals improved their staffing grades, while only 7% of non-general hospitals did. Greater likelihood of improvement in staffing grades was found in general hospitals located in metropolitan areas or having 250 or more beds. Conclusion: Elaboration of the financial incentive system is needed to increase the policy impact on staffing improvement.

• 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.

• Journal of Korean Academy of Nursing Administration
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• v.22 no.3
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• pp.209-219
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• 2016

Purpose: To analyze the proportion of medical institutions meeting the legal standard for nurse staffing. Methods: Data collected from 29,282 institutions between 1996 and 2013 were analyzed. Nurse staffing was measured as daily patient census per registered nurse (RN). The standard for general hospitals, hospitals, and clinics is 2.5 or less, and that for long-term care hospitals is 6.0 or less of the daily patient census per RN. Clinics may substitute nursing assistants for RNs by 50% or 100% depending on their daily inpatient census; long-term care hospitals may substitute nursing assistants for RNs by two thirds of the required number of RNs. Results: The proportion of general hospitals, hospitals, clinics, and long-term care hospitals meeting the standards was 63%, 19%, 63%, and 94%, respectively, in 2013. While general hospitals had an increase in the proportion during the 1996-2013 period, small changes were found in hospitals and clinics. In 2013, nurses were estimated to care for 16 (interquartile range: 12~24) patients per shift in general hospitals. Three quarters of clinics had no RNs in 2013. Conclusion: Many medical institutions did not meet the legally mandated minimum staffing level. The government must implement policy actions for all medical institutions to meet the legal standards.