Factors Related to Nurse Staffing Levels in Tertiary and General Hospitals

Kim Yun Mi,June Kyung Ja,Cho Sung-Hyun Korean Society of Nursing Science 2005 Journal of Korean Academy of Nursing Vol.35 No.8

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.

Nurse Staffing Level and Alternative Policy in the INCS

Jinhyun Kim,Hyunjeong Kwon 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): The aim of this study is to evaluate the adequacy of the nurse and nurse aid staffing level in an integrated nursing care service through calculating the actual nurse staffing level using the National Health Insurance Service (NHIS) data in South Korea. Method(s): This study is a retrospective study to evaluate the adequacy of the nurse staffing level. The NHIS data on integrated nursing care service staffing statistics and yearly claimed data were used to identify actual nursing personnel staffing. The ratio of actual staffing level to designated staffing level of each type of hospitals was calculated using the gathered data. Result(s): A total of 196 hospitals were selected for analyzing the ratio of actual nursing personnel to designated nursing personnel. Approximately 40 % of the hospitals’ employed nurses and nursing assistants are close to the threshold of the designated staffing level. In case of nurses, the tendency was more prominent in general hospital (43.5%) than semi & medium hospital (38.3%). Current distribution status of the ratio of actual nurse staffing level to designated nurse staffing level implies that it is difficult to cope with the fluctuations in the demand and supply of nursing personnel, leave and resignation of the nursing personnel and changes in bed occupancy rate. Conclusion(s): In order to minimize the expenditure on nursing personnel employment, approximately 40% of hospitals tightly manage their nursing personnel staffing level. This distribution tendency is difficult to cope with nursing needs and flexibility on the changes in workforce. As consequence, it may cause inefficiencies and difficulties in the management of nursing personnel in hospitals. Therefore, the development of new staffing standards to compensate for these limitations is necessary.

건강보험 간호간병통합서비스의 간호인력 배치수준에 대한 실증분석과 대안적 배치기준의 개발

김진현 ( Jinhyun Kim ),권현정 ( Hyunjeong Kwon ),이은희 ( Eunhee Lee ),정유미 ( Yoomi Jung ),김명자 ( Myungja Kim ),이선미 ( Sunmi Lee ),최하영 ( Hayoung Choi ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.2

본 연구의 목적은 국민건강보험 간호간병통합서비스의 적용을 받는 병동에서 간호인력 배치 수준이 임상현실에 적용됨에 있어 나타나는 문제점을 확인하고, 대안적 배치기준을 개발하는 것이다. 국민건강보험공단의 간호간병통합서비스 관련 통계 자료에 근거하여 간호사와 간호조무사의 실제 배치수준과 지정배치기준을 Ratio 분석법으로 평가하였다. 연구결과 196개 기관 중 약 40%에 해당하는 의료기관이 간호사와 간호조무사를 지정기준의 임계값에 근사하게 고용하는 것으로 나타났다. 이는 병상가동률의 변화, 휴직과 이직으로 인한 간호인력 고용 변화에 유연하게 대처하기 어렵다는 한계를 내포한다. 이러한 문제를 보완하기 위하여 간호사와 간호조무사 각각에 대해 설정된 현행 인력배치기준을 간호인력 1인당 환자수(ratio)의 개념으로 일원화하고, 간호사 비율에 따라 수가를 세분화하는 대안적 배치기준을 개발하였다. 이는 변동성이 높은 입원수요와 간호인력 수급 상황에 효과적으로 대응할 수 있고, 건강보험공단의 관리 효율성을 제고할 수 있는 장점이 있다. 의료기관 경영 측면에서는 이윤극대화를 위하여 간호사를 간호조무사로 대체하려는 부작용이 나타날 수 있으므로 엄격한 모니터링과 강화된 벌금제도가 필요하다. This study is aimed to evaluate the adequacy of staffing level in the integrated nursing care service(INCS) in South Korea and to develop a new INCS staffing level. The National Health Insurance Service(NHIS) data on INCS staffing statistics and yearly claimed data were used to identify actual nursing personnel staffing. The ratio of actual staffing level to designated staffing level was calculated using the gathered data. As a result, a total of 196 hospitals were collected for analyzing the ratio of actual staffing to designated staffing. Approximately 40% of the hospitals’ employed nurses and nursing assistants were close to the threshold of the designated staffing level. This implies that it is difficult to cope with the fluctuations of the number of patient and unexpected leave and resignation of the nursing personnel. To make up for those weak-points, a new staffing standard that unify the nurse and nurse assistant staffing level into the nursing personnel staffing level and subdivide the staffing level and medical fee according to the registered nurse retention ratio was developed. The new staffing standard can flexibly cope with fluctuation in severity of ward patients and ward conditions and also improve management efficiency of NHIS. However to prevent its side effect that replacing nurses with nurse assistants, it is required to execute a stringent monitoring and penalty system.

Effects of Nurse Staffing on Surgical Patient-Outcomes with Cerebrovascular Disease

Sunyoung Jang 보안공학연구지원센터 2016 International Journal of Bio-Science and Bio-Techn Vol.8 No.2

The purpose of this study was to examine the relationships between nurse staffing and patient outcomes including inpatient mortality and length of hospital stay. Data were obtained from the '2008 Korea National Patients Survey' conducted by the Korea Institute for Health and Social Affairs. The study sample consisted of inpatients with surgical cerebrovascular diseases (n= 728). Nurse staffing was measured using 2 indicators: number of beds per nurse and number of inpatient days per nurse. Hospital characteristics included size, location, ownership, and physician staffing. Patient characteristics were age, gender, primary diagnosis, admission route, type of surgery, and primary payer. Patient outcomes were mortality during hospitalization and length of hospital stay. After controlling for hospital and patient characteristics, the relationships of nurse staffing to inpatient mortality and length of hospital stay were analyzed by multilevel analysis. Nurse staffing was not significantly associated with inpatient mortality. Higher nurse staffing was related to a decrease in length of hospital stay. The study findings suggested that higher nurse staffing might decrease length of hospital stay, which could increase efficiency and profits in providing hospital services. Government and nursing policies are required to ensure adequate nurse staffing in hospitals.

Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units

Cho, Sung-Hyun,June, Kyung Ja,Kim, Yun Mi,Cho, Yong Ae,Yoo, Cheong Suk,Yun, Sung-Cheol,Sung, Young Hee Blackwell Publishing Ltd 2009 Journal of clinical nursing Vol.18 No.12

<P>Aim. </P><P>To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes.</P><P>Background. </P><P>Nurse staffing has been reported to influence patient and nurse outcomes.</P><P>Design. </P><P>A cross-sectional study with a survey conducted August–October 2007.</P><P>Methods. </P><P>The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes.</P><P>Results. </P><P>The average patient-to-nurse ratio was 2·8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3·26; 95% confidence interval, 1·14–9·31) or 2·0–2·5 patients (odds ratio, 2·44; 95% confidence interval, 1·32–4·52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2·97; 95% confidence interval, 2·22–3·97) in the odds of nurses’ rating high quality and decreases in the odds of dissatisfaction (odds ratio, 0·30; 95% confidence interval, 0·23–0·40), burnout (odds ratio, 0·50; 95% confidence interval, 0·34–0·73) and plan to leave (odds ratio, 0·40; 95% confidence interval, 0·28–0·56).</P><P>Conclusions. </P><P>Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units.</P><P>Relevance to clinical practice. </P><P>Adequate staffing must be assured to achieve better quality of care and job outcomes.</P>

중환자실에서 간호인력확보수준과 환자 예후와의 상관성

이현정,배홍범 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.2

Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea’s ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.

간호사 배치기준에 대한 정책적 함의

유선주(Sun-Ju You) 한국콘텐츠학회 2013 한국콘텐츠학회논문지 Vol.13 No.6

급성기 병원의 간호사 배치수준은 환자안전 및 성과에 영향을 미치며, 간호사 배치기준의 법제화는 환자 안전에 필요한 최소 인원을 보장하는 중요한 수단이 될 수 있다. 우리나라는 의료법에 간호사 정원기준을 제시하고 있으나, 환자안전 보장 및 간호의 질 향상을 위해서 다음의 몇 가지 사항에 대한 개선이 필요하다. 첫째 1962년 제정된 현행 의료법의 간호사 정원기준은 보건의료환경 변화에 따라 적정성에 대한 재검토가 필요하다. 둘째 의료법의 간호사 정원은 의료기관이 준수하여야할 최소 인원으로 모든 의료기관이 준수하도록 관리되어야 한다. 셋째, 간호사 배치기준은 환자의 이해를 돕고, 관리가 용이하도록 근무조당 입원환자 수 대 간호사 수를 기준으로 하도록 한다. 넷째, 병원 간호단위별 근무조별 간호인력 배치정보를 공개하여야 한다. 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.

Nurse Staffing and Patient Outcomes in Korea: A Systematic Review

Ji Yeon Lee(이지연) 한국산학기술학회 2021 한국산학기술학회논문지 Vol.22 No.1

본 연구의 목적은 체계적 문헌고찰을 통해 국내 급성기 병원 간호인력 배치 수준과 환자 건강 결과 간의 관계에 대한 연구를 체계적으로 평가하기 위함이다. 2009년 1월부터 2018년 12월까지 CINAHL, Pubmed, EBSCOhost, RISS, Dbpia 데이터베이스에 출판된 급성기 병원 간호인력 배치 수준과 환자 건강 결과 간의 관계에 대한 연구를 검색하였다. 국내 급성기 병원 간호 인력 배치 수준과 환자 건강 결과에 대한 관계를 파악한 연구 13편을 체계적으로 고찰하였다. 대부분의 연구에서 국내 급성기 병원의 간호 인력 배치 수준이 높을수록 환자 건강 결과가 제고됨을 확인하였다. 하지만, 몇몇 연구에서는 간호 인력과 환자 건강 결과 간의 유의한 관계가 없는 것으로 확인되었다. 이처럼 일관되지 않은 연구 결과는 연구들마다 서로 다른 측면의 간호 인력과 환자 건강 결과를 측정했기 때문인 것으로 사료된다. 이는 이와 관련한 지속적인 연구가 필요함을 시사한다. 환자 건강결과 향상을 위해 적정 수준의 환자 대 간호사 비율을 산정하고 이를 바탕으로 간호사들을 배치하는 전략 및 가이드라인을 세우기 위한 지속적인 노력이 필요하다. The purpose of this review was to systematically assess empirical studies on the relationship between nurse staffing and patient outcomes through systematic literature review. Peer-reviewed articles published between January 2009 and December 2018 were identified in CINAHL, Pubmed, EBSCOhost, RISS, and Dbpia databases. A total of 13 articles relating to nurse staffing and patient outcomes in Korea were systematically reviewed and analyzed. The review showed that better nurse staffing aligned with better patient outcomes. However, some studies did not directly correlate patient outcomes with nurse staffing. This is because each study examined varied aspects of nurse staffing and different patient outcomes. These inconsistent study results indicate that continuous study is required . There should be continued efforts to establish guidelines and strategies for deploying nurse staff by maintaining optimal patient-to-nurse ratio.

입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화

조성현,전경자,김윤미,박보현 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.2

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.

정신의료기관의 간호사 확보수준과 환자의 재원기간, 안전사고 실태

김경희,김숙자,김석선 한국자료분석학회 2017 Journal of the Korean Data Analysis Society Vol.19 No.1

The purpose of this study was to describe hospital characteristics, types of patients' hospitalization, patients' length of stay, number of safety accidents, and nurse staffing ratios in 75 psychiatric hospital settings. Data were analyzed using descriptive statistics, ANOVA. Findings showed that the mean of patients' length of stay was 235.88 and the average of nurse staffing ratios was 1: 12.01, indicating that one nurse would care for 50 patients every shift which are ten times higher than the average 4-5 patients of OECD countries. There was a significant difference in a patient's length of stay at the levels of nurse staffing ratios, reducing the ratio of nurse staffing has been shown to reduce patients' length of stay. The findings suggest that the amendment of nurse-to-patient ratio from 1:13 to 1:6 or below is required in the revised mental health act to reduce a patient's length of stay and to improve quality of nursing care. Also, in terms of calculating optimal nurse-to-patient ratios, registered nurse and nursing aides (nursing assistant) should be legislated as separate staff in the revised mental health act to optimize quality of care and to guarantee patient's safety as nursing aids have not received any education regarding public mental health and psychiatric and mental health nursing. 본 연구는 정신의료기관의 일반적 특성, 환자의 입원 유형, 재원기간, 안전사고, 간호사 및 간호보조인력 확보수준을 알아보기 위한 서술적 조사연구이다. 전국 소재 정신의료기관 75기관의 간호부서장을 대상으로 자료를 수집하여, 기술통계, ANOVA로 자료를 분석하였다. 연구결과, 정신의료기관의 평균 재원기간은 235.88±703.05로, 간호사 1인당 환자 수는 평균 12.01명으로 나타났다. 이는 간호사 3교대 근무조별로 간호사 1명이 50명의 환자를 담당하는 인력으로 OECD 국가 평균 간호사 1인이 환자 4-5명을 담당하는 것과 비교하여 약 10배 이상 많은 수이다. 간호사 확보수준에 따른 재원기간의 차이는 간호사 1인당 담당하는 환자수가 6명 이하 일 때 평균 재원기간이 유의하게 감소하는 것으로 나타났다. 반면, 간호사 확보수준에 따른 안전사고 건수는 모두 유의하지 않은 것으로 나타났다. 정신질환자의 재원기간을 줄이고 안전을 강화하기 위해서는 적정 간호사 인력을 현행 1:13에서 1:6 이하로 조정하여 법제화하는 것이 필요하다고 제언한다. 또한 정신보건법의 간호 인력에는 정신보건 및 정신간호에 대한 교육을 받지 않은 간호조무사가 포함되어 환자의 질적인 서비스 제공을 위해서는 간호사와 간호보조인력(간호조무사)에 대한 인력을 별도로 산정하는 법의 개정이 필요하다고 제언한다.