Skip Navigation
Skip to contents

J Korean Acad Nurs : Journal of Korean Academy of Nursing

OPEN ACCESS

Articles

Page Path
HOME > J Korean Acad Nurs > Volume 42(5); 2012 > Article
Original Article
Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients
Yunmi Kim1, Sung-Hyun Cho2, Kyung Ja June3, Soon Ae Shin4, Jiyun Kim5
Journal of Korean Academy of Nursing 2012;42(5):719-729.
DOI: https://doi.org/10.4040/jkan.2012.42.5.719
Published online: October 12, 2012

1Department of Nursing, Eulji University, Seongnam, Korea

2College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Korea

3Department of Nursing, Soonchunhyang University, Cheonan, Korea

4Department of Health Promotion & Management, National Health Insurance Corporation, Seoul, Korea

5Department of Nursing, Gachon University, Seongnam, Korea

1Department of Nursing, Eulji University, Seongnam, Korea

2College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Korea

3Department of Nursing, Soonchunhyang University, Cheonan, Korea

4Department of Health Promotion & Management, National Health Insurance Corporation, Seoul, Korea

5Department of Nursing, Gachon University, Seongnam, Korea

Address reprint requests to : Kim, Jiyun Department of Nursing, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam 461-701, Korea. Tel : +82-31-750-8822 Fax: +82-31-750-8859 E-mail: jkim@gachon.ac.kr
• Received: February 6, 2012   • Revised: February 22, 2012   • Accepted: September 25, 2012

Copyright © 2012 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 194 Views
  • 1 Download
  • 31 Crossref
prev next
  • Purpose
    This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance.
  • Methods
    Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes.
  • Results
    An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)= 2.99, 95% CI (confidence interval)= 1.94-4.60], those with Grades 4-5 (OR= 1.78, 95% CI= 1.24-2.57) and those with Grades 2-3 (OR= 1.57, 95% CI= 1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis.
  • Conclusion
    Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.
Table 1.
Characteristics of Hospitals
Variables Categories Hospital (n=182) Patients (n=111,491)
n (%) or M±SD n (%) or M±SD
Type Hospital 9 (5.0) 1,137 (1.0)
General hospital 129 (70.9) 36,972 (33.2)
Tertiary hospital 44 (24.2) 73,382 (65.8)
Ownership Medical cooperation 95 (52.2) 38,829 (34.8)
Educational foundation 57 (31.3) 47,771 (42.9)
Public 30 (16.5) 24,891 (22.3)
Location Small city 82 (45.1) 35,636 (32.0)
Metropolitan 100 (54.9) 75,855 (68.0)
Size (number of beds) 508.6±312.6
50-299 45 (24.7) 6,201 (5.6)
300-499 60 (33.0) 12,938 (11.6)
500-699 37 (20.3) 20,722 (18.6)
700-999 35 (19.2) 44,497 (39.9)
≥1000 5 (2.8) 27,133 (24.3)
Physician staffing 27.1±16.8
(number/100 beds) <10 28 (15.4) 3,071 (2.8)
10-19 55 (30.2) 8,137 (7.3)
20-29 24 (13.2) 8,373 (7.5)
30-39 29 (15.9) 23,552 (21.1)
40-49 32 (17.6) 41,980 (37.7)
≥50 14 (7.7) 26,378 (23.7)
Adjusted nurse staffing grade Grade 7 5 (2.8) 764 (0.7)
Grade 6 22 (12.1) 1,766 (1.6)
Grade 5 17 (9.3) 1,868 (1.7)
Grade 4 22 (12.1) 4,280 (3.8)
Grade 3 58 (31.9) 25,423 (22.8)
Grade 2 41 (22.5) 34,576 (31.0)
Grade 1 15 (8.2) 26,807 (24.0)
Grade 0 2 (1.1) 16,007 (14.4)
Table 2.
Characteristics of Patients (N=111,491)
Variables Categories n (%)
Age (year) 20-29 2,454 (2.2)
30-39 5,620 (5.0)
40-49 14,903 (13.4)
50-59 26,706 (24.0)
60-69 33,282 (29.9)
70-85 28,526 (25.6)
Gender Female 40,857 (36.7)
Health insurance type Self employees-dependants 11,952 (10.7)
Self employees-insured 28,458 (25.5)
Industrial workers-dependants 49,408 (44.3)
Industrial workers-insured 21,673 (19.4)
Income 1st quartile 17,972 (16.1)
2nd quartile 19,015 (17.1)
3rd quartile 28,360 (25.4)
4th quartile 46,144 (41.4)
Past history* Pneumonia 1,110 (1.0)
Sepsis 1,053 (0.9)
Urinary tract Infection 2,041 (1.8)
Admission route Emergency room 33,174 (29.8)
Outpatient department 78,317 (70.2)
Surgery Major craniotomy except for trauma 13,142 (11.8)
Other craniotomy except for trauma 3,177 (2.9)
Craniotomy for trauma Cardiac valve procedure with/without cardiac catheter 2,544 2,154 (2.3) (1.9)
Cardiac valve procedure with/without cardiac catheter Coronary bypass with/without cardiac catheter 2,154 2,138 (1.9) (1.9)
Coronary bypass with/without cardiac catheter 2,138 (1.9)
Major reconstructive vascular procedure 1,184 (1.1)
Percutaneous cardiovascular procedure 46,331 (41.6)
Amputation for circulatory system disorders 1,068 (1.0)
Rectal resection with/without complication and comorbidity 5,494 (4.9)
Major small and large bowel procedure 10,727 (9.6)
Stomach, esophageal and duodenal procedure 17,503 (15.7)
Pancreas, liver and shunt procedure 6,029 (5.4)
Severity 3-severe complication and comorbidity 2,152 (1.9)
2-moderate complication and comorbidity 14,868 (13.3)
1-minor complication and comorbidity 30,413 (27.3)
0-No complication and comorbidity 64,058 (57.5)

*Existence of past history is not mutually exclusive. To detect past history of pneumonia, sepsis and unrinary tract infection, related health problems, such as respiratory diseases, inflammatory diseases, and unrologic diseases, patients' claims were tracked.

Table 3.
In-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection by Nurse Staffing Level (N=111,491)
Variables Staffing grade Death Pneumonia Sepsis Urinary tract infection
Died Survived χ2 (p) Experienced Not experienced χ2 (p) Experienced Not experienced χ2 (p) Experienced Not experienced χ2 (p)
n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Total 6-7 180 (7.1) 2,350 (92.9) 286.97 83 (3.3) 2,447 (96.7) 69.40 53 (2.1) 2,477 (97.9) 35.28 155 (6.1) 2,375 (93.9) '118.59
4-5 178 (2.9) 5,970 (97.1) (<.001) 126 (2.0) 6,022 (98.0) (<.001) 68 (1.1) 6,080 (98.9) (<.001) 166 (2.7) 5,982 (97.3) (<.001)
2-3 1,768 (3.0) 58,231 (97.0) 732 (1.2) 59,267 (98.8) 609 (1.0) 59,390 (99.0) 1,329 (2.2) 5,8670 (97.8)
0-1 485 (1.1) 42,329 (98.9) 169 (0.4) 42,645 (99.6) 323 (0.8) 42,491 (99.2) 391 (0.9) 42,423 (99.1)
Tertiary 2-3 953 (2.8) 33,170 (97.2) 283.43 392 (1.2) 33,731 (98.8) 156.55 295 (0.9) 33,828 (99.1) 0.59 623 (1.8) 33,500 (98.2) 140.82
   hospital 0-1 431 (1.1) 38,828 (98.9) (<.001) 142 (0.4) 39,117 (98.6) (<.001) 319 (0.8) 38,940 (99.2) (.441) 327 (0.8) 38,932 (99.2) (<.001)
Hospital 6-7 180 (7.1) 2,350 (92.9) 158.66 83 (3.3) 2,447 (96.7) 85.43 53 (2.1) 2,477 (97.9) 54.46 155 (6.1) 2,375 (93.9) 113.61
& 4-5 178 (2.9) 5,970 (97.1) (<.001) 126 (2.1) 6,022 (97.9) (<.001) 68 (1.1) 6,080 (98.9) (<.001) 166 (2.7) 5,982 (97.3) (<.001)
general 2-3 815 (3.2) 25,061 (96.9) 340 (1.3) 25,536 (98.7) 314 (1.2) 25,562 (98.8) 706 (2.7) 25,170 (97.3)
   hospital 0-1 54 (1.5) 3,501 (98.5) 27 (0.8) 3,528 (99.2) 4 (0.1) 3,551 (99.9) 64 (1.8) 3,491 (98.2)
Table 4.
GEE Logistic Regression on Patient Outcome by Nurse Staffing Level (N=111,491)
Variables Categories Death Pneumonia Sepsis Urinary Tract Infection
OR p 95% CI OR p 95% CI OR p 95% CI OR p 95% CI
Age (year) 1.03 <.001 1.02-1.03 1.03 <.001 1.02-1.03 1.01 .023 1.00-1.02 1.02 <.001 1.02-1.03
Men (vs. women) 1.22 .001 1.09-1.37 1.56 <.001 1.32-1.84 1.22 .027 1.02-1.45 0.69 <.001 0.59-0.80
Severity (vs. 0-No CC) 3-severe CC 3.42 <.001 2.19-5.36 7.32 <.001 4.07-13.17 14.77 <.001 9.13-23.87 4.45 <.001 2.50-7.89
2-moderate CC 3.95 <.001 3.21-4.85 9.25 <.001 6.97-12.26 15.22 <.001 10.62-21.82 3.73 <.001 2.93-4.75
1-minor CC 2.55 <.001 2.16-3.02 6.54 <.001 5.15-8.30 8.06 <.001 5.71-11.37 2.53 <.001 2.14-2.99
Past history (vs. No) 1.13 .097 0.98-1.30 1.46 .004 1.13-1.89 1.65 <.001 1.40-1.94
Admission route ER (vs. OPD) 6.63 <.001 5.69-7.71 3.43 <.001 2.78-4.23 3.99 <.001 2.92-5.46 2.45 <.001 2.09-2.87
Health insurance Self employees-dependants 2.64 <.001 2.19-3.18 1.95 <.001 1.40-2.72 1.34 .085 0.96-1.86 1.17 .155 0.94-1.47
   type Self employees-insured 1.28 .004 1.08-1.52 1.40 .005 1.11-1.77 1.07 .598 0.83-1.39 1.04 .709 0.85-1.27
   (vs. Industrial workers-insured) Industrial workers-dependants 1.61 <.001 1.38-1.88 1.38 .018 1.06-1.81 1.24 .077 0.98-1.57 1.01 .918 0.83-1.23
Income 1st quartile 1.34 <.001 1.17-1.54 1.17 .137 0.95-1.43 1.04 .702 0.84-1.30 0.93 .348 0.80-1.08
   (vs.4th Quartile) 2nd quartile 1.19 .005 1.05-1.34 1.20 .053 1.00-1.45 1.09 .305 0.93-1.27 1.11 .203 0.95-1.30
3rd quartile 1.18 .004 1.05-1.32 1.07 .416 0.91-1.27 1.01 .925 0.88-1.15 1.05 .476 0.91-1.22
Type Hospital 1.28 .474 0.65-2.50 2.54 .141 0.73-8.82 1.18 .829 0.26-5.33 5.74 .033 1.15-28.55
   (vs. Tertiary hospital) General hospital 1.06 .586 0.86-1.30 0.92 .689 0.60-1.41 1.68 .094 0.91-3.10 1.03 .957 0.41-2.56
Ownership (vs. Public) Medical corporation 1.02 .886 0.79-1.32 0.60 .008 0.41-0.88 0.91 .738 0.51-1.61 1.01 .974 0.47-2.20
Educational foundation 1.27 .023 1.03-1.55 0.67 .061 0.44-1.02 0.84 .571 0.46-1.54 1.29 .588 0.51-3.28
Small city (vs. Metropolitan) 1.07 .886 0.93-1.23 0.93 .675 0.64-1.33 0.99 .941 0.68-1.44 1.22 .475 0.71-2.11
Physician staffing 0.81 .539 0.42-1.57 0.27 .087 0.06-1.21 13.14 .051 0.99-174.81 1 0.15 .041 0.03-0.92
Adjusted nurse staffing grade 6-7 2.99 <.001 1.94-4.60 2.79 .010 1.27-6.10 3.22 .010 1.33-7.82 1.68 .298 0.63-4.48
   (vs. 0-1) 4-5 1.78 .002 1.24-2.57 2.25 .070 0.94-5.44 1.86 .086 0.92-3.78 1.07 .884 0.43-2.66
2-3 1.57 <.001 1.25-1.98 1.73 .012 1.13-2.64 1.20 .462 0.74-1.92 1.34 .465 0.61-2.91

The results of surgery is not shown in the table; OR=Odds ratio; CI=Confidence Interval; CC=Complication and comorbidity; OPD=Outpatient department.

  • Aiken L. H., Clarke S. P., Cheung R. B., Sloane D. M., Silber J.H. 2003;Educational levels of hospital nurses and surgical patient mortality. The Journal of the American Medical Association. 290:1617–1623. http://dx.doi.org/10.1001/jama.290.12.1617ArticlePubMed
  • Aiken L. H., Clarke S. P., Sloane D. M., Sochalski J., Silber J.H. 2002;Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association. 288:1987–1993. http://dx.doi.org/10.1001/jama.288.16.1987ArticlePubMed
  • Aiken L. H., Sloane D. M., Cimiotti J. P., Clarke S. P., Flynn L., Seago J. A., et al. 2010;Implications of the California nurse staffing mandate for other states. Health Service Research. 45:904–921. http://dx.doi.org/10.1111/j.1475-6773.2010.01114.xArticle
  • Cho S.H. 2001;Nurse staffing and adverse patient outcomes: A systemic approach. Nursing Outlook. 49:78–85. http://dx.doi.org/10.1067/mno.2001.114381ArticlePubMed
  • Cho S. H., Hwang J. H., Kim, J. 2008;Nurse staffing and patient mortality in intensive care units. Nursing Research. 57:322–330. http://dx.doi.org/10.1097/01.NNR.0000313498.17777.71ArticlePubMed
  • Cho S. H., June K. J., Kim Y. M., Park B.H. 2008;Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. Journal of Korean Academy of Nursing Administration. 14:167–175.
  • Cho S. H., Ketefian S., Barkauskas V. H., Smith D.G. 2003;The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nursing Research. 52:71–79. http://dx.doi.org/10.1097/00006199-200303000-00003ArticlePubMed
  • Halm M., Peterson M., Kandels M., Sabo J., Blalock M., Braden R., et al. 2005;Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. Clinical Nurse Specialist. 19(5):241–251. http://dx.doi.org/10.1097/00002800-200509000-00007ArticlePubMed
  • Health Insurance Review & Assessment Service. 2009.KDRG categorization. Seoul: Author.
  • Kane R. L., Shamliyan T. A., Mueller C., Duval S., Wilt T.J. 2007a;The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care. 45:1195–1204. http://dx.doi.org/10.1097/MLR.0b013e3181468ca3PubMed
  • Kane R. L., Shamliyan T., Mueller C., Duval S., Wilt T.J. 2007b.Nurse staffing and quality of patient care. Evidence report/technology assessment No. 151 (Prepared by the Minnesota evidence-based practice center under contract No. 290-02-0009). Rockville: Agency for Healthcare Research and Quality.
  • Katz M.H. 2006.Multivariable analysis: A practical guide for clinicians. Cambridge: Cambridge University Press.
  • Kim Y.M. 2008;Nurse staffing level relating factors of the general nursing units, ICU, ER and OR in acute general hospitals. Journal of Korean Academy of Nursing Administration. 14:404–412.
  • Kim Y. M., Kim J. Y., June K. J., Ham E.O. 2010;Changing trend in grade of nursing management fee by hospital characteristics: 2008-2010. Journal of Korean Clinical Nursing Research. 16:99–109.
  • Korean Standard Statistical Classification. (n.d.). Classification of disease. Retrieved November 4, 2010, from. http://kostat.go.kr/kssc/main/MainAction.do?method=sub&catgrp=kssc&catid1=kssc03
  • Kunin C.M. 1984;Genitourinary infections in the patient at risk: Extrinsic risk factors. The American Journal of Medicine. 76:131–139. http://dx.doi.org/10.1016/0002-9343(84)90255-9ArticlePubMed
  • Ministry of Health and Welfare. 2006;Dec 18. Standard of medical care benefit and resource-based relative value scale of medical procedure. Retrieved January 19, 2011, from. http://www.mohw.go.kr/front/jb/sjb0402vw.jsp?PAR_MENU_ID=03&MENU_ID=030402&BOARD_ID=220&BOARD_FLAG=03&CONT_SEQ=39840&page=1
  • Needleman J., Buerhaus P., Mattke S., Stewart M., Zelevinsky, K. 2001.Nurse staffing and patient outcomes in hospitals. Contract No. 230-99-0021. Boston: Harvard University.
  • Needleman J., Buerhaus P. I., Stewart M., Zelevinsky K., Mattke, S. 2006;Nurse-staffing in hospital: Is there a business case for quality? Health Affairs. 25:204–211. http://dx.doi.org/10.1377/hlthaff.25.1.204ArticlePubMed
  • Newbold, D. 2008;The production economics of nursing: A discussion paper. International Journal of Nursing Studies. 45:120–128. http://dx.doi.org/10.1016/j.ijnurstu.2007.01.007ArticlePubMed
  • Newhouse R. P., Johantgen M., Pronovost P. J., Johnson, E. 2005;Perioperative nurses and patient outcomes-mortality, complications, and length of stay. AORN Journal. 81:508–528. http://dx.doi.org/10.1016/S0001-2092(06)60438-9ArticlePubMedPDF
  • Oman K. S., Makic M. B., Fink R., Schraeder N., Hulett T., Keech T., et al. 2012;Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control. 40:548–553. http://dx.doi.org/10.1016/j.ajic.2011.07.018ArticlePubMed
  • Park O. Y., Jung M.S. 2005;Analysis of the nursing interventions performed in the medical & surgical units and the health insurance cost items based on the NIC. Journal of Korean Academy of Nursing Administration. 11(4):1–19.
  • Park S.H. 2003;Analysis of direct nursing activity and patient outcomes related to graded fee of nursing management for inpatient. Journal of Korean Academy of Nursing. 33:122–129.ArticlePubMedPDF
  • Ranji S. R., Shetty K., Posley K. A., Lewis R., Sundaram V., Galvin C. M., et al. 2007.Closing the quality gap: A critical analysis of quality improvement strategies (Vol. 6: Prevention of healthcare-associated infections). (Report No. 04(07)-0051-6). Rockville: Agency for Healthcare Research and Quality.
  • Rochefort C. M., Clarke S.P. 2010;Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing. 66:2213–2224. http://dx.doi.org/10.1111/j.1365-2648.2010.05376.xArticlePubMed
  • Sochalski, J. 2004;Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Medical Care. 42(Suppl 2):II67–II73. http://dx.doi.org/10.1097/01.mlr.0000109127.76128.aaPubMed
  • van den Heede K., Clarke S. P., Sermeus W., Vleugels A., Aiken L.H. 2007;International experts' perspectives on the state of the nurse staffing and patient outcomes literature. Journal of Nursing Scholarship. 39:290–297. http://dx.doi.org/10.1111/j.1547-5069.2007.00183.xArticlePubMed
  • van den Heede K., Sermeus W., Diya L., Clarke S. P., Lesaffre E., Vleugels A., et al. 2009;Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data. International Journal of Nursing Studies. 46:928–939. http://dx.doi.org/10.1016/j.ijnurstu.2008.05.007ArticlePubMed
  • Wald H., Epstein A., Kramer, A. 2005;Extended use of indwelling urinary catheters in postoperative hip fracture patients. Medical Care. 43(10):1009–1017. http://dx.doi.org/10.1097/01.mlr.0000178199.07789.32ArticlePubMed

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  
    • Examining the experiences of mid-career nurses in hospitals: a phenomenological study
      Yukyung Ko, Soyoung Yu, Bohyun Park
      Contemporary Nurse.2024; 60(4): 333.     CrossRef
    • Differences in Medical Use and Patient Outcomes between Patients Admitted to the Integrated Nursing Care Ward and the General Ward
      Jeong Eun Mun, Bohyun Park
      Journal of Korean Academy of Nursing Administration.2024; 30(5): 439.     CrossRef
    • Experiences of Career Nurses Balancing Clinical Nursing with Ongoing Studies
      Yunhyung Kim, Yeonsook Joo, Eun Hee Kang, Jeong Hye Kim
      Journal of Korean Association for Qualitative Research.2024; 9(3): 215.     CrossRef
    • 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
      Hyun-Joo Kim, Sun-Hee Lee, Jai-Jung Lee, Sun-Suk Seong, Hee Yang, Hyang-Yuol Lee
      Journal of Korean Academy of Nursing.2024; 54(2): 237.     CrossRef
    • Exploring nurses' multitasking in clinical settings using a multimethod study
      Yoojin Kim, Mi Ja Lee, Mona Choi, Eunhee Cho, Gi Wook Ryu
      Scientific Reports.2023;[Epub]     CrossRef
    • Factors related to career interruption and Re‐employment of women in human health and social work activities sector: Comparison with other industry sectors
      Younghee Yun, Kyung Jin Hong
      Nursing Open.2023; 10(4): 2656.     CrossRef
    • Relationships between Alternative Nurse Staffing Level Measurements and Nurses’ Perceptions of Nurse Staffing Level Adequacy, Fatigue, and Care Quality
      Kyung Jin Hong, Hyesook Chung, Young Mi Jo, Paolo C. Colet
      Journal of Nursing Management.2023; 2023: 1.     CrossRef
    • Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis
      EunYoung Jeong
      Frontiers in Health Services.2023;[Epub]     CrossRef
    • The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study
      Miok Park, Eunjin Yang, Mimi Lee, Sung-Hyun Cho, Miyoung Shim, Soon Haeng Lee
      Journal of Korean Critical Care Nursing.2021; 14(2): 1.     CrossRef
    • Is Hospital Nurse Staffing Legislation in the Public’s Interest?
      Karen B. Lasater, Linda H. Aiken, Douglas M. Sloane, Rachel French, Colleen V. Anusiewicz, Brendan Martin, Kyrani Reneau, Maryann Alexander, Matthew D. McHugh
      Medical Care.2021; 59(5): 444.     CrossRef
    • The Relationship between Nursing Care Needs and Nurse Staffing in Pulmonology Nursing Units
      Hye-Kyung Jo, Sung-Heui Bae
      Korean Journal of Adult Nursing.2021; 33(3): 236.     CrossRef
    • Association between perioperative chlorhexidine oral care and postoperative pneumonia in non-cardiac surgical patients: A systematic review and meta-analysis
      Shiqi Liang, Xingxia Zhang, Yanjie Hu, Jie Yang, Ka Li
      Surgery.2021; 170(5): 1418.     CrossRef
    • Changes in Nurse Staffing Grades of Korean Hospitals during COVID-19 Pandemic
      Young-Taek Park, JeongYun Park, Ji Soo Jeon, Young Jae Kim, Kwang Gi Kim
      International Journal of Environmental Research and Public Health.2021; 18(11): 5900.     CrossRef
    • Relationship between hospital specialization and health outcomes in patients with nonsurgical spinal joint disease in South Korea
      Boyoung Jung, Jiyoon Yeo, Sun Jung Kim, In-Hyuk Ha
      Medicine.2021; 100(32): e26832.     CrossRef
    • Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data
      Yunmi Kim, Se Young Kim, Kyounga Lee
      BMC Nursing.2020;[Epub]     CrossRef
    • Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data
      Yunmi Kim, Hyun-Young Kim, Eunyoung Cho
      BMC Nursing.2020;[Epub]     CrossRef
    • Evaluating Nursing Needs in the Neonatal Intensive Care Unit with the Korean Patient Classification System for Neonatal Intensive Care Nurses
      Hyo nam An, Sukhee Ahn
      Journal of Korean Critical Care Nursing.2020; 13(2): 24.     CrossRef
    • A multilevel investigation of cultural competence among South Korean clinical nurses
      Duckhee Chae, Yunhee Park, Kyeonghwa Kang, Jongdae Kim
      Scandinavian Journal of Caring Sciences.2020; 34(3): 613.     CrossRef
    • Influence of Hospital Nurse Staffing Levels on the Colorectal Cancer Evaluation Grades, Mortality, and Length of Stay
      Yunmi Kim, Se Young Kim
      Korean Journal of Adult Nursing.2019; 31(5): 479.     CrossRef
    • Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data
      Yunmi Kim, Jiyun Kim, Soon Ae Shin
      International Journal of Nursing Studies.2019; 89: 104.     CrossRef
    • The association between nurse staffing levels and paediatric nursing-sensitive outcomes in tertiary hospitals
      Chul-Gyu Kim, Ji-Soo Kim
      Journal of Nursing Management.2018; 26(8): 1002.     CrossRef
    • Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study
      Chul-Gyu Kim, Kyun-Seop Bae
      International Journal of Nursing Studies.2018; 80: 155.     CrossRef
    • The Impact of Nurse Staffing on In-Hospital Mortality of Stroke Patients in Korea
      Wankyo Chung, Min Sohn
      Journal of Cardiovascular Nursing.2018; 33(1): 47.     CrossRef
    • Effect of nurse staffing variation and hospital resource utilization
      Yunmi Kim, Seon‐Ha Kim, Young Ko
      Nursing & Health Sciences.2016; 18(4): 473.     CrossRef
    • Relationship between Medical Service Specialization and Operational Performance in Hospitals: Focusing on Length of Stay and Medical Expense
      Hai-Won Yoo, Kyoung-Hoon Kim
      The Korean Journal of Health Service Management.2016; 10(1): 1.     CrossRef
    • Nurse Staffing Levels and Proportion of Hospitals and Clinics Meeting the Legal Standard for Nurse Staffing for 1996~2013
      Sung-Hyun Cho, Ji-Yun Lee, Kyung-Ja June, Kyung Jin Hong, Yunmi Kim
      Journal of Korean Academy of Nursing Administration.2016; 22(3): 209.     CrossRef
    • Impact of Nurse Staffing Level and Oral Care on Hospital Acquired Pneumonia in Long-term Care Hospitals
      Jung Mi Chae, Hyunjong Song, Gunseog Kang, Ji Yun Lee
      Journal of Korean Academy of Nursing Administration.2015; 21(2): 174.     CrossRef
    • Impact of a financial incentive policy on Korean nurse staffing
      Y. Kim, J. Kim
      International Nursing Review.2015; 62(2): 171.     CrossRef
    • A Delphi Study to Elicit Policies for Nurse Workforce based on Patient Safety
      Sung Ok Chang, Byoung Sook Lee, Jong Im Kim, Sung Rae Shin
      Journal of Korean Academy of Nursing Administration.2014; 20(2): 215.     CrossRef
    • Analysis on Satisfaction of Nursing Services for Elderly hospitalized in Attended Ward and General Ward
      Mee-Suk Wang, In Deok Lee, M.S. Kang, Eun-Kwang Cha, Dae-Ho Choi, Hyeon-Cheol Jeong
      Journal of the Korea Academia-Industrial cooperation Society.2014; 15(5): 3014.     CrossRef
    • 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
      Journal of Korean Academy of Nursing Administration.2013; 19(5): 565.     CrossRef

    • Cite
      CITE
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients
      J Korean Acad Nurs. 2012;42(5):719-729.   Published online October 12, 2012
      Close
    • XML DownloadXML Download
    We recommend
    Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients
    Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients
    Variables Categories Hospital (n=182) Patients (n=111,491)
    n (%) or M±SD n (%) or M±SD
    Type Hospital 9 (5.0) 1,137 (1.0)
    General hospital 129 (70.9) 36,972 (33.2)
    Tertiary hospital 44 (24.2) 73,382 (65.8)
    Ownership Medical cooperation 95 (52.2) 38,829 (34.8)
    Educational foundation 57 (31.3) 47,771 (42.9)
    Public 30 (16.5) 24,891 (22.3)
    Location Small city 82 (45.1) 35,636 (32.0)
    Metropolitan 100 (54.9) 75,855 (68.0)
    Size (number of beds) 508.6±312.6
    50-299 45 (24.7) 6,201 (5.6)
    300-499 60 (33.0) 12,938 (11.6)
    500-699 37 (20.3) 20,722 (18.6)
    700-999 35 (19.2) 44,497 (39.9)
    ≥1000 5 (2.8) 27,133 (24.3)
    Physician staffing 27.1±16.8
    (number/100 beds) <10 28 (15.4) 3,071 (2.8)
    10-19 55 (30.2) 8,137 (7.3)
    20-29 24 (13.2) 8,373 (7.5)
    30-39 29 (15.9) 23,552 (21.1)
    40-49 32 (17.6) 41,980 (37.7)
    ≥50 14 (7.7) 26,378 (23.7)
    Adjusted nurse staffing grade Grade 7 5 (2.8) 764 (0.7)
    Grade 6 22 (12.1) 1,766 (1.6)
    Grade 5 17 (9.3) 1,868 (1.7)
    Grade 4 22 (12.1) 4,280 (3.8)
    Grade 3 58 (31.9) 25,423 (22.8)
    Grade 2 41 (22.5) 34,576 (31.0)
    Grade 1 15 (8.2) 26,807 (24.0)
    Grade 0 2 (1.1) 16,007 (14.4)
    Variables Categories n (%)
    Age (year) 20-29 2,454 (2.2)
    30-39 5,620 (5.0)
    40-49 14,903 (13.4)
    50-59 26,706 (24.0)
    60-69 33,282 (29.9)
    70-85 28,526 (25.6)
    Gender Female 40,857 (36.7)
    Health insurance type Self employees-dependants 11,952 (10.7)
    Self employees-insured 28,458 (25.5)
    Industrial workers-dependants 49,408 (44.3)
    Industrial workers-insured 21,673 (19.4)
    Income 1st quartile 17,972 (16.1)
    2nd quartile 19,015 (17.1)
    3rd quartile 28,360 (25.4)
    4th quartile 46,144 (41.4)
    Past history* Pneumonia 1,110 (1.0)
    Sepsis 1,053 (0.9)
    Urinary tract Infection 2,041 (1.8)
    Admission route Emergency room 33,174 (29.8)
    Outpatient department 78,317 (70.2)
    Surgery Major craniotomy except for trauma 13,142 (11.8)
    Other craniotomy except for trauma 3,177 (2.9)
    Craniotomy for trauma Cardiac valve procedure with/without cardiac catheter 2,544 2,154 (2.3) (1.9)
    Cardiac valve procedure with/without cardiac catheter Coronary bypass with/without cardiac catheter 2,154 2,138 (1.9) (1.9)
    Coronary bypass with/without cardiac catheter 2,138 (1.9)
    Major reconstructive vascular procedure 1,184 (1.1)
    Percutaneous cardiovascular procedure 46,331 (41.6)
    Amputation for circulatory system disorders 1,068 (1.0)
    Rectal resection with/without complication and comorbidity 5,494 (4.9)
    Major small and large bowel procedure 10,727 (9.6)
    Stomach, esophageal and duodenal procedure 17,503 (15.7)
    Pancreas, liver and shunt procedure 6,029 (5.4)
    Severity 3-severe complication and comorbidity 2,152 (1.9)
    2-moderate complication and comorbidity 14,868 (13.3)
    1-minor complication and comorbidity 30,413 (27.3)
    0-No complication and comorbidity 64,058 (57.5)
    Variables Staffing grade Death Pneumonia Sepsis Urinary tract infection
    Died Survived χ2 (p) Experienced Not experienced χ2 (p) Experienced Not experienced χ2 (p) Experienced Not experienced χ2 (p)
    n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
    Total 6-7 180 (7.1) 2,350 (92.9) 286.97 83 (3.3) 2,447 (96.7) 69.40 53 (2.1) 2,477 (97.9) 35.28 155 (6.1) 2,375 (93.9) '118.59
    4-5 178 (2.9) 5,970 (97.1) (<.001) 126 (2.0) 6,022 (98.0) (<.001) 68 (1.1) 6,080 (98.9) (<.001) 166 (2.7) 5,982 (97.3) (<.001)
    2-3 1,768 (3.0) 58,231 (97.0) 732 (1.2) 59,267 (98.8) 609 (1.0) 59,390 (99.0) 1,329 (2.2) 5,8670 (97.8)
    0-1 485 (1.1) 42,329 (98.9) 169 (0.4) 42,645 (99.6) 323 (0.8) 42,491 (99.2) 391 (0.9) 42,423 (99.1)
    Tertiary 2-3 953 (2.8) 33,170 (97.2) 283.43 392 (1.2) 33,731 (98.8) 156.55 295 (0.9) 33,828 (99.1) 0.59 623 (1.8) 33,500 (98.2) 140.82
       hospital 0-1 431 (1.1) 38,828 (98.9) (<.001) 142 (0.4) 39,117 (98.6) (<.001) 319 (0.8) 38,940 (99.2) (.441) 327 (0.8) 38,932 (99.2) (<.001)
    Hospital 6-7 180 (7.1) 2,350 (92.9) 158.66 83 (3.3) 2,447 (96.7) 85.43 53 (2.1) 2,477 (97.9) 54.46 155 (6.1) 2,375 (93.9) 113.61
    & 4-5 178 (2.9) 5,970 (97.1) (<.001) 126 (2.1) 6,022 (97.9) (<.001) 68 (1.1) 6,080 (98.9) (<.001) 166 (2.7) 5,982 (97.3) (<.001)
    general 2-3 815 (3.2) 25,061 (96.9) 340 (1.3) 25,536 (98.7) 314 (1.2) 25,562 (98.8) 706 (2.7) 25,170 (97.3)
       hospital 0-1 54 (1.5) 3,501 (98.5) 27 (0.8) 3,528 (99.2) 4 (0.1) 3,551 (99.9) 64 (1.8) 3,491 (98.2)
    Variables Categories Death Pneumonia Sepsis Urinary Tract Infection
    OR p 95% CI OR p 95% CI OR p 95% CI OR p 95% CI
    Age (year) 1.03 <.001 1.02-1.03 1.03 <.001 1.02-1.03 1.01 .023 1.00-1.02 1.02 <.001 1.02-1.03
    Men (vs. women) 1.22 .001 1.09-1.37 1.56 <.001 1.32-1.84 1.22 .027 1.02-1.45 0.69 <.001 0.59-0.80
    Severity (vs. 0-No CC) 3-severe CC 3.42 <.001 2.19-5.36 7.32 <.001 4.07-13.17 14.77 <.001 9.13-23.87 4.45 <.001 2.50-7.89
    2-moderate CC 3.95 <.001 3.21-4.85 9.25 <.001 6.97-12.26 15.22 <.001 10.62-21.82 3.73 <.001 2.93-4.75
    1-minor CC 2.55 <.001 2.16-3.02 6.54 <.001 5.15-8.30 8.06 <.001 5.71-11.37 2.53 <.001 2.14-2.99
    Past history (vs. No) 1.13 .097 0.98-1.30 1.46 .004 1.13-1.89 1.65 <.001 1.40-1.94
    Admission route ER (vs. OPD) 6.63 <.001 5.69-7.71 3.43 <.001 2.78-4.23 3.99 <.001 2.92-5.46 2.45 <.001 2.09-2.87
    Health insurance Self employees-dependants 2.64 <.001 2.19-3.18 1.95 <.001 1.40-2.72 1.34 .085 0.96-1.86 1.17 .155 0.94-1.47
       type Self employees-insured 1.28 .004 1.08-1.52 1.40 .005 1.11-1.77 1.07 .598 0.83-1.39 1.04 .709 0.85-1.27
       (vs. Industrial workers-insured) Industrial workers-dependants 1.61 <.001 1.38-1.88 1.38 .018 1.06-1.81 1.24 .077 0.98-1.57 1.01 .918 0.83-1.23
    Income 1st quartile 1.34 <.001 1.17-1.54 1.17 .137 0.95-1.43 1.04 .702 0.84-1.30 0.93 .348 0.80-1.08
       (vs.4th Quartile) 2nd quartile 1.19 .005 1.05-1.34 1.20 .053 1.00-1.45 1.09 .305 0.93-1.27 1.11 .203 0.95-1.30
    3rd quartile 1.18 .004 1.05-1.32 1.07 .416 0.91-1.27 1.01 .925 0.88-1.15 1.05 .476 0.91-1.22
    Type Hospital 1.28 .474 0.65-2.50 2.54 .141 0.73-8.82 1.18 .829 0.26-5.33 5.74 .033 1.15-28.55
       (vs. Tertiary hospital) General hospital 1.06 .586 0.86-1.30 0.92 .689 0.60-1.41 1.68 .094 0.91-3.10 1.03 .957 0.41-2.56
    Ownership (vs. Public) Medical corporation 1.02 .886 0.79-1.32 0.60 .008 0.41-0.88 0.91 .738 0.51-1.61 1.01 .974 0.47-2.20
    Educational foundation 1.27 .023 1.03-1.55 0.67 .061 0.44-1.02 0.84 .571 0.46-1.54 1.29 .588 0.51-3.28
    Small city (vs. Metropolitan) 1.07 .886 0.93-1.23 0.93 .675 0.64-1.33 0.99 .941 0.68-1.44 1.22 .475 0.71-2.11
    Physician staffing 0.81 .539 0.42-1.57 0.27 .087 0.06-1.21 13.14 .051 0.99-174.81 1 0.15 .041 0.03-0.92
    Adjusted nurse staffing grade 6-7 2.99 <.001 1.94-4.60 2.79 .010 1.27-6.10 3.22 .010 1.33-7.82 1.68 .298 0.63-4.48
       (vs. 0-1) 4-5 1.78 .002 1.24-2.57 2.25 .070 0.94-5.44 1.86 .086 0.92-3.78 1.07 .884 0.43-2.66
    2-3 1.57 <.001 1.25-1.98 1.73 .012 1.13-2.64 1.20 .462 0.74-1.92 1.34 .465 0.61-2.91
    Table 1. Characteristics of Hospitals

    Table 2. Characteristics of Patients (N=111,491)

    *Existence of past history is not mutually exclusive. To detect past history of pneumonia, sepsis and unrinary tract infection, related health problems, such as respiratory diseases, inflammatory diseases, and unrologic diseases, patients' claims were tracked.

    Table 3. In-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection by Nurse Staffing Level (N=111,491)

    Table 4. GEE Logistic Regression on Patient Outcome by Nurse Staffing Level (N=111,491)

    The results of surgery is not shown in the table; OR=Odds ratio; CI=Confidence Interval; CC=Complication and comorbidity; OPD=Outpatient department.


    J Korean Acad Nurs : Journal of Korean Academy of Nursing
    Close layer
    TOP