Draft Conceptual Framework for Nurse Staffing and Patient Outcomes Study
Study Concept
Group
Administrative
Practices/Setting
Variable Group
Staffing volume
relative to service
volume including
quantity (dose) of
nursing attentioni
Variable and Data Element
Description
Nursing hours per patient day
OR
Nurse to patient ratio
OR
Nurse staff full-time
equivalent employment (FTEE)
Key Assumptions








Staffing mix
Type of nursing staff (share of
RN,LVN/LPN,UAP)
Experience levels of staff
Organizational
environment
Hospital size, specialty, and
service type (critical access
hospital, community, tertiary,
teaching status)
Type of institution (individual
hospital or health system)
Type and complexity of
nursing delivery unit/ service
(e.g. intensive care)
Includes registered nurse (RN), licensed
vocational/practical nurse (LVN/LPN), unlicensed
assistive personnel (UAP), and contract nurses.
Only includes inpatient “productive hours” and
excludes non-patient care hours for documentation,
supervision, care coordination and other non-inpatient
care as well as time off for illness, vacation or
continuing education.
Nurse to patient ratio is expressed as:
Measurement and
Data Source
Hospital staffing
reports from payroll
or management
system.
Full-time nursing staff is assumed to have “productive
hours” of 85 percent of a potential of 52 weeks per
year at 40 hours per week, resulting in 1,768 potential
hours per year: FTEE = Total nursing hours/1,768.
Data is provided at the inpatient care unit level and
provided in both medical/surgical and intensive care
categories.
A patient day is 24 hours.
Is adjusted for patient turnover.
Is adjusted for patient acuity.
Page 1
Study Concept
Group
Administrative
Practices/Setting
(cont.)
Variable Group
Organizational
environment (cont.)
Variable and Data Element
Description
Hospital unit culture, nurse
role and autonomy
Key Assumptions
Measurement and
Data Source
Nurse care staff satisfaction/
voluntary turnover
Physical layout of hospital unit
Health information technology
Method of care delivery
Health care unit
activity
Others?
Patient Care
Patient turnover
Patient medical needs Reason for admission, clinical
service type, patient acuity,
discharge status, disposition
of patient
Care delivery
Dates of service (length of
stay), complexity of clinical
decision making
Patient demographics Age, gender, payment source
Others?
Patient Outcomes
Nurse-sensitive
indicators
Death among surgical
inpatients with treatable
serious complications (failure
to rescue)
Pressure ulcer prevalence
Patient falls
Restraint prevalence
Medication administration
accuracy
Catheter associated blood
stream infections
Others?
Page 2
i
The staffing example relies heavily on Spetz J et al. (2008). How Many Nurses per Patient? Health Services Research; 43:5 Part I, 1674-1691.
Page 3