Measuring up: Are nurse staffing measures adequate for health services research?

Abstract

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

Citation

Unruh, L., Allison Russo, C., Joanna Jiang, H. and Stocks, C. (2009), "Measuring up: Are nurse staffing measures adequate for health services research?", Savage, G.T. and Fottler, M.D. (Ed.) Biennial Review of Health Care Management: Meso Perspective (Advances in Health Care Management, Vol. 8), Emerald Group Publishing Limited, Leeds, pp. 115-154. https://doi.org/10.1108/S1474-8231(2009)0000008009