• 임상간호연구
• /
• 제29권3호
• /
• pp.312-326
• /
• 2023

Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results: Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. Conclusion: The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.

• 재활간호학회지
• /
• 제14권1호
• /
• pp.62-69
• /
• 2011

Purpose: The study assessed whether nurse staffing was associated with 3 nursing sensitive outcomes used in intensive care unit (ICU) nursing care plans. Methods: This study was a retrospective and descriptive study using clinical data extracted from the data warehouse of a large acute care hospital in the Midwest. One-way analysis of variance was used to analyze the records of 578 ICU patients admitted from March 25 to May 31, 2010. Results: 79 Nursing Outcomes Classification (NOC) outcomes were used in the nursing care plans. The 3 most commonly used NOC outcomes (Pain Level, Infection Severity, and Tissue Integrity: Skin and Mucous Membranes) were analyzed to determine their relationship to nurse staffing. As a nurse staffing ratio, the skill mix of nursing caregivers ranged from 0.74 to 1 with an average of 0.90. This skill mix of nursing caregivers significantly differed among the changes in Infection Severity scores. However, the mean difference was only 0.02. Conclusion: The results did not support that greater nurse staffing was associated with better outcomes. More research is still needed to determine the usefulness of Pain Level, Infection Severity, and Tissue Integrity: Skin and Mucous Membranes in evaluating the impact of nurse staffing.

• 보건행정학회지
• /
• 제17권2호
• /
• pp.68-90
• /
• 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.

• 대한간호학회지
• /
• 제47권6호
• /
• pp.828-841
• /
• 2017

Purpose: This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Methods: Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. Results: An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). Conclusion: To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future.

• 간호행정학회지
• /
• 제22권3호
• /
• pp.209-219
• /
• 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.

• 대한간호학회지
• /
• 제50권3호
• /
• pp.333-348
• /
• 2020

Purpose: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. Methods: The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. Results: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. Conclusion: Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.

• 중환자간호학회지
• /
• 제14권2호
• /
• pp.1-11
• /
• 2021

Purpose : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients' nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods : In a cross-sectional survey conducted in September 2017, 1,786 patients' WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients' nursing care needs were calculated. Results : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients' nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

• 대한간호학회지
• /
• 제36권5호
• /
• pp.691-700
• /
• 2006

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.

• 간호행정학회지
• /
• 제23권2호
• /
• pp.211-222
• /
• 2017

Purpose: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. Methods: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. Results: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. Conclusion: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

• 대한간호학회지
• /
• 제26권2호
• /
• pp.399-412
• /
• 1996

Even though Korean medical law stipulates that number of patients attended by a nurse is 2.5 for hospitalization and 30 for ambulatory care, the number of patients cared by a nurse per day is much greater than the standard prescribed by the medical law. Current nursing productivity of nurses is not desirable unless the quality of care considered. Moreover. nursing manpower staffing based on neither current nurses' productivity nor standard of medical law cannot respond properly to dynamic situation of the medical services. As for the nurse scheduling, the critical problem of it in the hospital is determining the day-to-day shift assignments for each nurse for the specified period in a way that satisfies the given requirements of the hospital. Nurse scheduling, however, involves many factors and requirements, manual scheduling requires much time and effort to produce an adequate schedule. Under these backgrounds, the necessity of more efficient management of nursing manpower occupying 1/3 of total hospital workers has been recognized by many nursing administrators. This study was performed to develop a system computerizing nurse staffing and scheduling based on the patient classification. As a preliminary step for the system development, nursing workload in a secondary hospital was measured from Sep. to Oct. 1994. On the grounds of this result, computerization of nurse staffing and scheduling was proceeded with three options. First one is based on the current medical law. Second one is based on the assigned number of nursing staff. And the last is based on the request by patient classification. Computer languages used in this study were MS Visual Basic 3.0 for the staffing and Access 2.0 for the scheduling, respectively. Prospective users may operate this system easily because icons and mouse are used for easier graphic user interface and reducing the need for typing efforts. This system can help nurse administrators manage nursing manpower efficiently and nurses develop quick and easy schedule generation and allow more time for the patient care.