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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 l.jpg

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 l.jpg
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


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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


Nursing care intensity l.jpg
Nursing Care Intensity

  • Indicators of nursing care intensity:

  • Patient acuity

  • Patient turnover


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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


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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.


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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?


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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


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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


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Results

Average Patient Length of Stay in

Pennsylvania Hospitals, 1991-2000


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Results

Average Patient Turnover in Pennsylvania Hospitals 1991-2000


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Results

RN/1,000 APDC in

Pennsylvania Hospitals 1991-2000

p<.01=*, p<.001=**, p<.0001=***


Results13 l.jpg
Results

LPN/1,000 APDC in

Pennsylvania Hospitals 1991-2000

p<.01=*, p<.001=**, p<.0001=***


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Results

NA/1,000 APDC in

Pennsylvania Hospitals 1991-2000

p<.01=*, p<.001=**, p<.0001=***


Results15 l.jpg
Results

Percentage Change in RN/1,000 APDC in Pennsylvania Hospitals

p<.01=*, p<.001=**, p<.0001=***


Results16 l.jpg
Results

Percentage Change in LPN/1,000 APDC in Pennsylvania Hospitals

p<.01=*, p<.001=**, p<.0001=***


Results17 l.jpg
Results

Percentage Change in NA/1,000 APDC in Pennsylvania Hospitals

p<.01=*, p<.001=**, p<.0001=***


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Results

Percentage Change in Nursing Staff/1,000 APDC in Pennsylvania Hospitals 1991-2000

p<.01=*, p<.001=**, p<.0001=***


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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


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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