Journal List > J Korean Acad Nurs Adm > v.17(3) > 1051599

Lee, Ko, and Kim: The Effects of Medical Staffing Level on Length of Stay



The objective of this study was to analyze the effects of medical staffing level as bed-to-medical staff ratio on patient outcomes as length of stay (LOS) among hospitals in Korea.


Two hundred and fifty one hospitals participated in the study between January and March 2008. Data for the study was requested by an electronic data interchange from the Health Insurance Review Agency in 2008. In data analysis, SPSS WIN 15.0 program was utilized for descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression.


The mean score for length of stay was 13.6 days. The mean of operating bed-to-nurse ratio was 7.93:1. The predicting factors for LOS were bed-to-nurse's aide ratio, bed-to doctor's ratio, severely ill patient rate, and hospital type. These factors explained 28.9% of the variance in patient outcomes.


This study results indicate that the relationship between medical staffing level and patient outcomes is important in the improvement of the quality of patient care. Thus, improvements in the quality of the nurse practice environment could improve patient outcomes for hospitalized patients.

Figures and Tables

Table 1
General characteristics of the hospitals (N=259)

1) Tertiary Hospital - over 100 beds and designated by medical law, General Hospital - over 100 beds, Hospital - 30-99 beds

Table 2
Patient outcome (LOS) according to general characteristics (N=259)

1) Tertiary Hospital - over 100 beds and designated by medical law, General Hospital - over 100 beds, Hospital - 30-99 beds

Table 3
Correlations of study variables

X1= Number of operating beds; X2= Operating Bed-to-Nurse ratio; X3= Operating Bed-to-doctor ratio; X4= Operating Bed-to-nurse's aide; X5= Elderly patient rate; X6= Severely ill patient rate; X7= Length of Stay (days);

Table 4
Factors affecting LOS


1. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber J. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003. 290(12):1617–1623.
2. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008. 38(5):223–229.
3. Anand S, Barnighausen T. Human resources and health outcomes: Cross-country econometric study. Lancet. 2004. 364:1603–1609.
4. Blegen MA, Goode CJ, Reed L. Nurse staffing and patient outcomes. Nurs Res. 1998. 47:43–50.
5. Blegen MA. Patient safety in hospital acute care units. Annu Rev Nurs Res. 2006. 24:103–125.
6. Cho SH, Jeon KJ, Kim YM, Park BH. Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. J Korean Acad Nurs Adm. 2008. 14(2):167–175.
7. Cohen JW, Spector WD. The effect of medicaid reimbursement on quality care in nursing homes. J Health Econ. 1996. 15:23–48.
8. Douglas D, Robb A. Clarifying outcomes in clinical practice. Nurs Stand. 1995. 9(24):29–30.
9. Friese CR, Lake ET, Aiken LH, Silber JH, Sochalski J. Hospital nurse practice environments and outcomes for surgical oncology patients. Health Serv Res. 2007. 43(4):1145–1163.
10. Gulliford MC. Availability of primary care doctors and population health in England: Is there an association? J Public Health Med. 2002. 24:252–254.
11. Hartz AJ, Krakauer EM, Huhn M, Young SJ, Jacobsen G, Gay L, et al. Hospital characteristics and mortality rates. N Engl J Med. 1989. 321(25):1720–1725.
12. Jarman B, Gault S, Alves B, et al. Expanding differences in English hospital death rates using routinely collected data. BMJ. 1999. 318:1515–1520.
13. Kanda K, Kodama S. Determinants of nursing service in urban public hospitals: An economic perspective. Nurs Health Sci. 2002. 4:63–72.
14. Ko YK, Kim BJ. An analysis of nurse staffing level and nursing performance in the general unit. J Korean Acad Nurs Adm. 2008. 14(4):413–420.
15. Kovner C, Jones C, Zhan C, Gergen P, Basu J. Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of US hospitals, 1990-1996. Health Serv Res. 2002. 37(3):611–629.
16. Kwon YD. Severity-adjusted mortality rates of coronary artery bypass graft surgery in Korea. 1998. Seoul: Seoul National University of Korea;Unpublished doctoral dissertation.
17. Lee SH. Multi-level analysis of factors related to quality of services in long-term care hospitals. J Korean Acad Nurs. 2009. 39(3):409–421.
18. Lee SH, Yoo SJ, Kim BJ, Kim YM, Ryu MK, Park IT, et al. 2007 Hospital evaluation program: Survey report. 2008. Seoul: Korea Health Industry Development Institute.
19. Lohr KN. Outcome measurement: Concepts and questions. Inquiry. 1988. 25(1):37–50.
20. Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: Practice-makes-perfect or selective-referral patterns? Health Serv Res. 1987. 22(2):157–182.
21. Needleman J, Buerhaus PI, Stewart M, Zelevinsky K, Mattke S. Nurse staffing in hospitals: Is there a business case for quality? Health Aff (Millwood). 2006. 25(1):204–211.
22. Nessling R. Bevan S, editor. Manpower Monograph 2-Skill mix: A practical approach for health professionals. Choosing an approach to reprofiling and skill mix, for NHSME/Personnel Development Division. 1990. London: 1.
23. Or Z. Determinants of health outcomes in industrialized countries: A pooled cross country time series analysis. OECD Econ Stud. 2000. 30:53–75.
24. Park SH. Analysis of direct nursing activity and patient outcomes related to graded fee of nursing management for inpatient. J Korean Acad Nurs. 2003. 33(1):122–129.
25. Perrin JM, Valvona J. Does increased physician supply affect quality of care? Health Aff (Millwood). 1986. 5:63–72.
26. Schubert M, Glass TR, Clarke SP, Aiken LH, Schaffert-Witvliet B, Sloane DM, et al. Rationing of nursing care and its relationship to patient outcomes: The Swiss extension of the international hospital outcomes study. Int J Qual Health Care. 2008. 20(4):227–237.
27. Sloan FA, Perrin JM, Valvona J. In-hospital mortality of surgical patients: Is there an empiric basis for standard setting? Surgery. 1986. 99(4):446–454.
28. Spector WD, Takada HA. Characteristics of nursing homes that affect resident outcomes. J Aging Health. 1991. 3:427–454.
29. Stordeur S, D'Hoore W. Organizational configuration of hospitals succeeding in attracting and retaining nurses. J Adv Nurs. 2007. 57(1):45–58.
30. Weissman JS, Rothschild JM, Bendavid E, et al. Hospital workload and adverse events. Med Care. 2007. 45:448–455.
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