Paper
Friday, 21 July 2006
This presentation is part of : Issues and Initiatives in the Workforce
Nursing Levels and Hospital Outcomes: An Empirical Analysis of Hospital Production in Ontario, Canada
Gail Tomblin Murphy, PhD, RN, School of Nursing and Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada, Stephen Birch, PhD, McMaster University, Hamilton, ON, Canada, and Linda O'Brien-Pallas, RN, PhD, Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Learning Objective #1: identify barriers that are need to be addressed to carry out needs based HHR planning.
Learning Objective #2: describe ways to measure and account for population health needs in health human resources planning.
We analyse the association between nursing inputs, hospital bed days and patient outcomes in acute care hospitals to determine whether greater levels of nursing inputs are associated with lower levels of other inputs, indicating a substitution of human for non-human resources,  and whether any such substitution of inputs is achieved at the expense of health outcomes.
Data/methods: The study used hospital level utilization data from administrative data bases and self reported individual level data from a population health survey for Ontario, Canada. Logistic regression methods were used to estimate models for the incidence of utilisation and a double-hurdle model was employed to account for heterogeneity in the study sample. 
Results: After controlling for supply of nurses, workload, community characteristics and hospital type, nursing hours per patient day had a significant negative effect on patients’ length of stay. In other words, the more nursing hours in a hospital, the shorter the average length of patient stays in that hospital.
Conclusion: We found that greater intensity of nursing inputs is associated with shorter lengths of stay with no evidence that this resulted in poorer patient outcomes as measured by higher rates of readmission, lower levels of patient satisfaction or lower levels of self reported health.  The analysis emphasizes the importance of considering levels of human resources in the context of the levels of other health care inputs and the outcomes that the mixes of inputs produce.  Such information is important to both health care managers and planners in their efforts to deploy efficient mixes of health care resources and identify future human resource requirements to support the efficient provision of health human resources. 

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