Nurse Staffing
The UHC operational dataset used the most informative
method of measuring the amount of nursing care
provided on inpatient care units: the hours of direct
caregivers (RNs, licensed practical nurses [LPNs], and
nursing assistants [NAs]) per patient day in each inpatient
unit. Precision was further increased by capturing
the worked hours exclusive of management
and clinical specialist hours, counting patients on the
units for observation or short stay in addition to
those counted in the midnight (MN) patient census,
and separating the nurse staffing according to patient’s
needs for ICU or general (non-ICU) care.
Two nurse staffing variables were used in this
study. First, the total hours of nursing care per patient
day (Tot HPPD) for each unit was calculated by dividing
the total hours of direct patient care from RNs,
LPNs, and NAs in each quarter by the total number
of adjusted patient days in the quarter on the unit.
The adjusted patient days are calculated by adding,
to the MN census counts, 1 day for each 24 hours of
observation and short-stay patient time on the unit
(ie, patients not officially admitted and staying less
than 24 hours). The RN skill mix (RN mix) was calculated
for each unit by dividing the RN hours by the
total hours. Because the intensity of nurse staffing is
much greater on ICUs, and combining both types of
units would obscure the effects of the specific staffing
patterns, staffing for general adult units were kept
separate from those on adult ICUs. Nurse staffing
data were aggregated to the hospital level to link with