All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Larry R Hearld

Stephen J O'Connor

Patricia A Patrician

Bisakha Sen

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

The purpose of this study is to inquire into the relationships among contextual factors (i.e., environmental and organizational factors), nurse staffing patterns, and hospital performance in terms of quality of care, cost, and profitability. The study is divided into three papers. Paper one reviews the literature on the relationship between contextual factors, nurse staffing patterns, and hospital performance. Paper two is an empirical study measuring the relationship between contextual factors and nurse staffing patterns. Paper three is also an empirical study; it measures the relationship between nurse staffing patterns and hospital performance in terms of quality of care, cost, and profitability. The literature review targeted hospital studies that were published between 1984 and 2013. The study included only peer-reviewed, English written, quantitative research conducted in the U.S. and Canada. The empirical studies used data from a national sample of U.S. non-federal, general, acute-care hospitals between 2006 and 2010. The datasets for analysis in papers two and three were drawn selectively from databases of the Medicare Cost Report, the American Hospital Association Annual Survey Database, the Area Resource File, the Hospital Compare Data, the Case Mix Index File, the Local Area Unemployment Statistics, and the Magnet Hospital status data. Key findings indicated: a) ample empirical results on the positive relationship between registered nurse (RN) staffing and quality were found in the literature; b) the literature had insufficient empirical evidence concerning contextual factors that influence hospital nurse staffing patterns and the relationship between nurse staffing patterns and hospital financial performance; c) operating environments with higher per capita income, an urban location, more specialists, higher competition, and a membership in a multihospital system were associated with more RNs per 1,000 inpatient days in hospitals; d) an increase in RNs per 1,000 inpatient days was associated with a decrease in pneumonia readmission rate and an increase in operating costs and profitability; e) a decrease in pneumonia readmission rate was associated with an increase in profitability; and f) the positive relationship between RNs per 1,000 inpatient days and profitability was mediated by pneumonia readmission rate.

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