Value of Nurse Practitioner Inpatient Hospital Staffing : Medical Care

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Value of Nurse Practitioner Inpatient Hospital Staffing

Aiken, Linda H. PhD*,†; Sloane, Douglas M. PhD*; Brom, Heather M. PhD*,†,‡; Todd, Barbara A. DNP*,§; Barnes, Hilary PhD*,∥; Cimiotti, Jeannie P. PhD*,¶; Cunningham, Regina S. PhD*,§; McHugh, Matthew D. PhD, JD*,†

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Medical Care 59(10):p 857-863, October 2021. | DOI: 10.1097/MLR.0000000000001628



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.


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)].


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.


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


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.


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

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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