Nurse Staffing Patterns and Patient Experience of Care: An Empirical Analysis of U.S. Hospitals

Objective To examine the relationship between nurse staffing patterns and patients’ experience of care in hospitals with a particular focus on staffing flexibility. Data Sources/Study Setting The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. Study Design An observational research design was used entailing a pooled, cross‐sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full‐time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix—percentage of registered nurses; staffing flexibility—percentage of part‐time nurses). Principal Findings All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed‐effects analysis. A higher percentage of part‐time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Conclusions Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns.