Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #103913

Lynn Unruh, PhD, RN and Myron D. Fottler, PhD. Health Services Administration Program, University of Central Florida, HPA-2, Rm 210L, Orlando, FL 32816-2200, (407) 823-4237, lunruh@mail.ucf.edu

Theoretical Framework: Measures of nurse staffing calculate the volume of nurses or nurse hours given the volume of patients or patient days. Frequently, intensity of nursing care is also considered by adjusting patient volume for patient acuity. However, intensity of nursing care is also affected by many other factors, an important one being patient turnover. As patient turnover increases, nurses must do more in each patient day of care. Holding patient acuity and nursing care requirements for the patient stay constant, as patient turnover increases, a similar amount of nursing care must be delivered in a shorter period of time (Dellit et al., 2001). Also, as turnover increases, intensive procedures such as admission, transfer, and discharge take up an increasing proportion of the patient's stay (Cavouras, 2002). Therefore, measures of nurse staffing that do not incorporate patient turnover may not accurately reflect nursing workload.

Research Design and Methods: Using data from Pennsylvania acute-care general hospitals from 1994 through 2001, we examine the trend in patient turnover and its impact on the measurement of registered nurses (RNs) per adjusted patient days of care (APDC). We develop two turnover indices from the inverse of patient length of stay, using 1994 as the base year. After multiplying APDC by the indices, we perform paired sample t tests to examine the significance of the difference in nurse staffing measures with and without the turnover adjustments. This is done at the yearly level and given the percentage change from year to year. We also examine differences in staffing when both patient turnover and patient acuity are included.

Results: Average patient length of stay fell 21% from 1994 to 2001 in Pennsylvania hospitals. Patient turnover increased 29%. After applying the turnover indices to nurse staffing measures, the difference between the original and adjusted measures was increasingly significant over time. These results also applied to the changes in nurse staffing. With the new measures, RN staffing fell between 10 to 20% over the eight years, compared to a 1% decrease with the original measure. When patient acuity is included, the new measures indicate a 16 to 26% decline in RN staffing over this time period.

Discussion: These results provide evidence that the assessment of nurse staffing by nurse to patient ratios alone will underestimate nursing needs. Patient turnover, or both patient turnover and patient acuity, should be taken into account in staffing assessment and decision-making.

Learning Objectives: Participants will be able to

• Define patient turnover.
• Explain how patient turnover impacts the intensity of nursing care.
• Describe a new measure for nurse staffing that includes patient turnover.
• Compare the differences in nurse staffing over time using standard measures, and ones adjusted for patient turnover.
• Describe the changes in nurse staffing in Pennsylvania hospitals from 1994 to 2001 when both patient acuity and turnover are included in the measures.

Keywords: Nurses, Staff Retention

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.