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Recent Trends in Hospital Nurse Staffing in the United States

Staggs, Vincent S. PhD; He, Jianghua PhD

doi: 10.1097/NNA.0b013e31829d620c

Objective: The aim of this study was to examine recent trends in nurse staffing levels and nursing staff composition.

Background: Recent trends in hospital nurse staffing have not been well described, and the effects of the 2007 to 2012 recession and 2008 Centers for Medicare & Medicaid Services rule change are unknown.

Methods: A longitudinal study of unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and hospital-level data from the American Hospital Association (AHA) annual survey was conducted.

Results: From 2004 to 2011, total nursing hours per patient day on general care units in NDNQI hospitals increased by 11.5%, and registered nurse (RN) hours per patient day by 22.9%. Trends were similar in AHA hospitals.

Conclusions: Hospitals have steadily increased total nurse staffing levels by increasing RN staffing. Use of temporary RNs in hospitals plummeted from mid-2008. There were no apparent changes in staffing levels due to the recession and/or CMS rule change.

Author Affiliations: Research Assistant Professor, Department of Biostatistics and School of Nursing (Dr Staggs); Associate Professor, Department of Biostatistics (Dr He), University of Kansas Medical Center, Kansas City.

Funding for this work was provided by the American Nurses Association.

The authors declare no conflicts of interest.

Correspondence: Dr Staggs, Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins