The 130th Annual Meeting of APHA

Abstract #45506

Lynn Unruh, PhD, RN¹, Myron D. Fottler, PhD¹, and Laura Talbott, BS, MA². (1) Health Services Administration Program, University of Central Florida, HPA-2, Rm 210L, Orlando, FL 32816-2200, (407) 823-4237, lunruh@mail.ucf.edu, (2) Student Health Services, University of Central Florida, University of Central Florida, Tr 618, Orlando, FL 32816-3333

For a number of years, health service researchers have had difficulty objectively verifying the growing impression of a decline in nursing staff and an increase in nurses' patient load in hospitals (Bond and Raehl, 2000; Buerhaus, 1999). The problem persists even when reports of nursing shortages abound. The usual explanation is that patient acuity has risen and accounts for the impression of higher workloads (Aiken, Sochalski & Anderson, 1996). Yet nurses report increased numbers of patients, in addition to higher levels of acuity (FNHP, 2001). So the increase in acuity does not fully account for the reports of higher workload.

There are several methodological possibilities for the difficulty in establishing an increase in nursing patient load. One issue relates to the use of "adjusted patient days of care" (APDC) as the measure for patient load. This measure is composed of hospital inpatient days of care (the number of patients times their length of stay) plus estimated outpatient days of care. APDC is a useful measure of patient load in a hospital if the nursing staff positions or hours include nurses working in both inpatient and outpatient hospital settings. One problem with the measure, however, is that it does not count the inpatient's last day in the hospital. While this may have been instituted as a weighting mechanism due to the uncertainty of the time of day for both admission and discharge, the potential for underestimating workload associated with a patient stay is great.

Using data from Pennsylvania acute-care general hospitals from 1991 to 2001, we adjust APDC to include one-half of the final inpatient day, and we examine the difference in RN, LPN, and nursing assistant patient load before and after making the adjustment. We also examine the trend in patient load over this time period, and compare the change in patient load given the two different patient-load indicators. We run paired-sample t tests to test for significant differences between the cross-sectional and longitudinal results.

We hypothesize that the difference in patient load between samples, as well as the difference in the change in patient load from 1991 to 2001, will be significant for all nursing staff, and that RN and LPN patient loads using the adjusted measure will demonstrate a significant increase from 1991-2001. Initial examination of data from 1991-1997 indicates that the adjusted measure produces a significantly greater change in patient load for all nursing staff for most years.

Learning Objectives: Participants will be able to

• Describe the discrepancy between research results and practitioner and consumer reports of nursing staff patient load.
• Describe the measures of nursing staff patient load using APDC and APDC adjusted for the final inpatient day of care
• Compare the differences in nursing staff patient load using the two different measures.
• Compare the differences in changes in nursing staff patient load using the two different measures.
• Evaluate the trend in nursing staff patient load using the adjusted measure.

Keywords: Nurses, Staff Retention

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Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.