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Research Paper
Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design
Kim, Hyun-Joo , Lee, Sun-Hee , Lee, Jai-Jung , Seong, Sun-Suk , Yang, Hee , Lee, Hyang-Yuol
J Korean Acad Nurs 2024;54(2):237-249.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.22142
AbstractAbstract PDF
Purpose
This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload.
Methods
The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively.
Results
The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload.
Conclusion
These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.
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Original Articles
The Clinical Experiences of Adaptation as a New Nursing Staff
Haeng Mi Son, Moon Hee Koh, Chun Mi Kim, Jin Ha Moon
Journal of Korean Academy of Nursing 2001;31(6):988-997.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.6.988
AbstractAbstract PDF

PURPOSE: This study aimed at uncovering the experience of adaptation of the new nursing staff in hospital setting.
METHODS
For this study, 15 new graduate nurses participated. The data was collected through the in-dept interviews and analysed in terms of Strauss and Corbin's grounded theory methodology.
RESULTS
The core category was identified with "entering orbit". The new graduate nurses, who experienced the taeoom because of their unskilled professions, tried to enter orbit by overcoming difficult situations through reducing stress, maintaining good interpersonal relationship, grasping, compensating, persisting, and introspecting. Noticeably, in the process of adaptation, negative image of nursing, conflict of interpersonal relationship and the educational program for the new nursing staff had effect on the intervening factors. Finally, this study confirmed that the processes of new nurses' adaptation are confusing, confrontating, becoming a member and settling in hospital setting.
CONCLUSION
Therefore, the educational programs reflecting new nursing staffs' experiences should be developed.

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Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels
Bohyun Park, Sukyung Seo, Taejin Lee
J Korean Acad Nurs 2013;43(1):39-49.   Published online February 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.1.39
AbstractAbstract PDF
Purpose

To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing.

Methods

Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions.

Results

For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable.

Conclusion

The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

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  • Empirical Analysis of Geographic Inequalities in the Distribution of Nurses
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A Proposal to Improve Nursing Fee Differentiation Policy for General Hospitals Using Profitability-Analysis in the National Health Insurance
Sungjae Kim, Jinhyun Kim
J Korean Acad Nurs 2012;42(3):351-360.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.351
AbstractAbstract PDF
Purpose

The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy.

Methods

A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance.

Results

The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades.

Conclusion

Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

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    Sujin Shin, Jong Duck Park, Juh Hyun Shin
    Asian Nursing Research.2020; 14(2): 57.     CrossRef
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    Yu Kyung Ko, Bo-Hyun Park
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  • Financial Projection of the Nursing Fee Differentiation Policy Improvement Proposal in the National Health Insurance: Using a Break-even Analysis Model for the Optimal Nursing Fee
    Sungjae Kim, Jinhyun Kim
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Factors Impacting the Physical Function of Older Adults in Korean Long-Term Care Hospitals
Ji-Yun Lee, Eun-Young Kim, Eunhee Cho
J Korean Acad Nurs 2011;41(6):780-787.   Published online December 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.6.780
AbstractAbstract PDF
Purpose

This study was conducted to examine activities of daily living (ADL) of older adults admitted to Korean long-term care hospitals (LTCHs), and to explore the patient and organizational factors that have an impact on the ADL of this population.

Methods

A secondary analysis of the Korean minimum data set (K-MDS) of patients (N=14,369) and of the profiles of LTCHs (N=358) from the Health Insurance Review and Assessment Service was done between January and July 2008. The outcome variable was ADL score 6 months after baseline assessment. Multi-level linear regression was employed to explore the patient and organizational factors that affected ADL scores.

Results

Of the patients, 45.4% had a baseline ADL score of between 31 and 40, with a score of 40 indicating that the patient was entirely dependent for all items. None of the organizational characteristics were significantly associated with effects on the ADLs of older adults who had been in a LTHC for at least 6 months. However, patient characteristics, such as age, baseline ADL, frequency of physical therapy, urinary incontinence, fecal incontinence, pressure ulcers, and having a tube or catheter, were significantly associated with ADL 6 months after baseline.

Conclusion

In order to maintain and improve the ADL of older adults in LTCHs, we should develop strategies to prevent urinary and fecal incontinence, pressure ulcers, unnecessary tubes or catheters, providing adequate physical therapy. Additional studies should include more detailed information regarding nursing staff, including RN hours for direct care, education level and turnover.

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Nurses' Experience of Career Ladder Programs in a General Hospital
Kwang-Ok Park, Myungsun Yi
J Korean Acad Nurs 2011;41(5):581-592.   Published online October 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.5.581
AbstractAbstract PDF
Purpose

The purpose of this study was to identify and describe nurses' experience of a career ladder program (CLP) in a general hospital in Korea.

Methods

The data were collected from 15 nurses who participated in the CLP. Each nurse completed individual in-depth interviews, for which the main interview question was "How do you describe your experience of CLP?". All interview data were transcribed and were analyzed using the grounded theory method.

Results

The core category of the experience of CLP was identified as "challenging to rebirth as an expert". The participants used five action/interaction strategies such as "taking some time for introspection", "appreciating the essence of nursing", "making use of feedback positively", "throwing away doubts about their own capabilities", "exerting themselves with confidence". The consequence of the process of adjusting to CLP was "positioning a differentiated expert."

Conclusion

The results of this study show that participants recognized CLP as a powerful resource which leads them to professional growth and development. Thus, CLP could be utilized as a clinical career-promoting program and ultimately as a program for providing high-quality nursing services.

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    Mee Ran Park, Nam Cho Kim
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