Address correspondence to Lynn Y. Unruh, Ph.D., RN, LHRM Associate Professor of Health Services Administration, Department of Health Professions College of Health and Public Affairs 210L HPA2, University of Central Florida, Orlando, FL 32816. Myron D. Fottler, Ph.D., is Professor and Director of Health Services Administration Program, Department of Health Professions College of Health and Public Affairs, University of Central Florida, Orlando, FL.
Patient Turnover and Nursing Staff Adequacy
Article first published online: 4 JAN 2006
Health Services Research
Volume 41, Issue 2, pages 599–612, April 2006
How to Cite
Unruh, L. Y. and Fottler, M. D. (2006), Patient Turnover and Nursing Staff Adequacy. Health Services Research, 41: 599–612. doi: 10.1111/j.1475-6773.2005.00496.x
- Issue published online: 4 JAN 2006
- Article first published online: 4 JAN 2006
- RN staffing;
- nurse staffing;
- patient turnover;
- patient throughput;
- length of stay;
- healthcare workforce;
- nursing workforce;
- nursing care intensity
Objective. To assess the relative validity of patient turnover adjustments and the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not.
Data Sources. Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute care general hospitals in Pennsylvania 1994–2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system.
Study Design. After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two-patient turnover indices, with and without patient severity adjustments, to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests.
Data Extraction Methods. Data sets were match merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC, and APDC adjusted for patient turnover and both patient turnover and severity.
Principal Findings. Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1995 onward. Unadjusted RN staffing showed a 1 percent decline over the 8-year-period compared with decreases of from 9 to 26 percent after adjustments.
Conclusions. These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making.