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Organizational Factors Associated With Technical Efficiency of Nursing Care in US Intensive Care Units

Min, Ari, PhD, RN; Scott, Linda D., PhD, RN, NEA-BC, FAAN; Park, Chang, PhD; Vincent, Catherine, PhD, RN; Ryan, Catherine J., PhD, RN, APN, CCRN, FAHA

doi: 10.1097/NCQ.0000000000000362

Background: Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs).

Purpose: To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care.

Methods: A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency.

Results: Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals.

Conclusions: A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.

Yonsei University College of Nursing, Seoul, South Korea (Dr Min); School of Nursing, University of Wisconsin-Madison, Madison (Dr Scott); and University of Illinois at Chicago College of Nursing, Chicago (Drs Park, Vincent, and Ryan).

Correspondence: Ari Min, PhD, RN, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea (

Ari Min has received research grants from Midwest Nursing Research Society and Sigma Theta Tau International, Alpha Lambda Chapter.

The authors declare no conflict of interest.

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Accepted for publication: July 8, 2018

Published ahead of print: September 11, 2018

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