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. 2021 Oct 1;59(10):857-863.
doi: 10.1097/MLR.0000000000001628.

Value of Nurse Practitioner Inpatient Hospital Staffing

Linda H Aiken  1   2 , Douglas M Sloane  1 , Heather M Brom  1   2   3 , Barbara A Todd  1   4 , Hilary Barnes  1   5 , Jeannie P Cimiotti  1   6 , Regina S Cunningham  1   4 , Matthew D McHugh  1   2
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Value of Nurse Practitioner Inpatient Hospital Staffing

Linda H Aiken et al. Med Care. .

Abstract

Background: Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.

Objective: The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.

Research design: This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].

Subjects: RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.

Measures: Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.

Results: After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.

Conclusions: Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.

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Conflict of interest statement

The authors declare no conflict of interest.

References

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    1. Sloane DM, Smith HL, McHugh MD, Aiken LH. Effect of changes in hospital nursing resources on improvements in patient safety and quality of care: A panel study. Med. Care 2018;56:1001–1008. - PMC - PubMed
    1. Aiken LH, Sloane DM, Bruyneel L, et al.Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet. 2014;383(9931):1824–1830. - PMC - PubMed
    1. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med. Care 2011;49(12):1047–1053. - PMC - PubMed
    1. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–1993. - PubMed

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