J Korean Clin Nurs Res.  2022 Apr;28(1):1-12. 10.22650/JKCNR.2022.28.1.1.

Effects of Nurse Staffing Level on In-hospital Mortality and 30-day Mortality after Admission using Korean National Health Insurance Data

• Kim Y
• Lee K
• Kim HY

• KMID: 2529717
• DOI: http://doi.org/10.22650/JKCNR.2022.28.1.1

Abstract

Purpose
The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data.
Methods
The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x ² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission.
Results
The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00).
Conclusion
To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

Keyword

Hospital Mortality; Nurses; Personnel Staffing and Scheduling; Intensive Care Units