Value of Nurse Practitioner Inpatient Hospital Staffing

Abstract

Background: 

Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.

Objective: 

The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.

Research Design: 

This was a 2015–2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1–2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].

Subjects: 

RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.

Measures: 

Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.

Results: 

After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)²=0.76; 95% confidence interval (CI)=0.67–0.82; P<0.001] and 7-day readmissions (OR²=0.90; 95% CI=0.86–0.96; P<0.001), shorter average length of stay (incident rate ratio²=0.92; 95% CI=0.88–0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%–7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.

Conclusions: 

Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.