Patients' interpretations of the quality of care they receive during a hospital stay is largely dependent on the care they receive from nurses. As hospitals face a shortage of nurses and financial constraints, there is concern that they're responding by reducing nurse staffing to levels that may compromise patient care. In this study, researchers examined nurse staffing patterns and patients' experience of care, focusing particularly on staffing flexibility (that is, the percentage of part-time to full-time staff).

Data on nurse staffing came from the American Hospital Association Annual Survey and data on patient experience of care came from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey conducted by the Centers for Medicare and Medicaid Services. These data were combined for the years 2010 through 2012. The final study sample included 3,026 U.S. general hospitals for which the researchers had complete data for the following three variables: staffing levels, staffing skill mix, and staffing flexibility.

The researchers found that nurse staffing patterns influence patient experiences of care. A higher staffing level and skill mix (a higher percentage of RNs to LPNs), and greater staffing flexibility, were all positively and significantly associated with patient experience of care, but only the effect of staffing flexibility on patient experience remained significant when unobserved hospital characteristics (such as size, type of ownership, and teaching status) were included in the analysis.

The researchers found that staffing flexibility was the most important variable they examined, and proposed that because of the positive effect of working part-time on quality of patient care, it may "contribute to a more positive work environment for nurses." The authors note that because "staffing levels, skill mix, and staffing flexibility interact in ways that seemingly affect how nurses perform their work[horizontal ellipsis] hospital managers need to carefully consider that adjustments to one staffing variable may amplify the effects of other staffing variables for patient experience of care."-KC

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