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Patient Turnover and Nursing Staff Adequacy

Patient Turnover and Nursing Staff Adequacy. Lynn Unruh, PhD, RN, LHRM Myron D. Fottler, PhD. AcademyHealth Annual Research Meeting San Diego, June 6-8, 2004. Research Problem. Common hospital nurse staffing measures: nurses or hours of nursing care patients or patient days of care

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Patient Turnover and Nursing Staff Adequacy

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  1. Patient Turnover and Nursing Staff Adequacy Lynn Unruh, PhD, RN, LHRM Myron D. Fottler, PhD AcademyHealth Annual Research Meeting San Diego, June 6-8, 2004

  2. Research Problem • Common hospital nurse staffing measures: nurses or hours of nursing care patients or patient days of care • Need to also consider intensity of nursing care • Staffing needs vary with the amount and type of care provided for each of those patients

  3. Research Problem • An ideal measure of nursing staff adequacy should indicate the volume of nurses of a certain skill level that is necessary for the given volume of patients given the intensity of nursing care required for those patients during their stay: # of RNs # of patient days X intensity of RN care for those patient days

  4. Nursing Care Intensity • Indicators of nursing care intensity: • Patient acuity • Patient turnover

  5. Patient Turnover • As patient turnover increases • Nursing care must be delivered in a shorter period of time • Holding patient acuity and total nursing care requirements for the patient stay constant • Admission, transfer, and discharge procedures take up an increasing proportion of the patient’s stay

  6. Patient Turnover • An available measure for patient turnover is patient length of stay • The number of days a patient is an inpatient in the hospital. • The inverse of patient length of stay produces a fraction that ranges between 0 and 1 • Lower amounts indicate lower turnover, and vice versa.

  7. Research Questions • Does adjusting nurse staffing data for patient turnover, as measured by the inverse of patient LOS, significantly alter the measurement of nurse staffing and changes in nurse staffing? • What is the trend in nurse staffing when measures adjust for both patient turnover and patient acuity?

  8. Sample and Data Sources • All general, acute-care Pennsylvania hospitals 1991-2000 (N= 166-213) • Data obtained from: • Pennsylvania Department of Health • Yearly filled RN, LPN and Nursing Assistant FTEs • American Hospital Association • APDC* and LOS • Patient days of care include outpatient care • Atlas MediQual System • Patient acuity

  9. Design • Assess the trend in the average patient LOS and turnover (inverse of length of stay). • Create a patient turnover index using 1991 as the base year, and adjust nurse staffing measures for patient turnover using this index • Compare the standard and new measures using paired sample t-tests • Assess whether the trend over time in nurse staffing utilizing the new measure is significantly different than the old measure using paired sample t-tests • Analyze the trend in nurse staffing adjusted for both patient turnover and acuity

  10. Results Average Patient Length of Stay in Pennsylvania Hospitals, 1991-2000

  11. Results Average Patient Turnover in Pennsylvania Hospitals 1991-2000

  12. Results RN/1,000 APDC in Pennsylvania Hospitals 1991-2000 p<.01=*, p<.001=**, p<.0001=***

  13. Results LPN/1,000 APDC in Pennsylvania Hospitals 1991-2000 p<.01=*, p<.001=**, p<.0001=***

  14. Results NA/1,000 APDC in Pennsylvania Hospitals 1991-2000 p<.01=*, p<.001=**, p<.0001=***

  15. Results Percentage Change in RN/1,000 APDC in Pennsylvania Hospitals p<.01=*, p<.001=**, p<.0001=***

  16. Results Percentage Change in LPN/1,000 APDC in Pennsylvania Hospitals p<.01=*, p<.001=**, p<.0001=***

  17. Results Percentage Change in NA/1,000 APDC in Pennsylvania Hospitals p<.01=*, p<.001=**, p<.0001=***

  18. Results Percentage Change in Nursing Staff/1,000 APDC in Pennsylvania Hospitals 1991-2000 p<.01=*, p<.001=**, p<.0001=***

  19. Results Nursing Staff/1,000 Adjusted APDC* in Pennsylvania Hospitals 1991-2000 % Change 1991-2000: RNs -44% LPNs -65% NAs -48% *APDC adjusted for patient acuity and turnover

  20. Conclusions • Unadjusted nurse workload measures fail to adequately address the work intensity issue and, consequently, significantly underestimate nurse workloads • Perceptions of nurses themselves, the media, and others concerning increasing nurse workloads/declining staffing ratios are justified and supported by our results • Future research on nurse staffing or nurse workload issues should adjust for both patient acuity and patient turnover

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