Health Care Manage Rev. 2021;46(4):266-277. doi: 10.1097/HMR.0000000000000262.
Privatization is one of the strategies that public hospitals may adopt to remain competitive. Privatized hospitals may implement nurse staffing cuts as a cost-saving mechanism and to increase financial performance. A better understanding of how privatization may affect nurse staffing is important given its association with patient and organizational outcomes.
The aim of this study was to examine the impact of not-for-profit (NFP) and for-profit (FP) privatizations of public hospitals on nurse staffing.
METHODOLOGY/APPROACH: Based on secondary data sets from the American Hospital Association Annual Survey, the Centers for Medicare & Medicaid Services Impact Files, and the Area Health Resources File, this study used a nonexperimental longitudinal design consisting of negative binomial and linear regression models with hospital level and year fixed effects. Our sample consisted of nonfederal and noncritical access, acute care, public hospitals (n = 492) followed from 1997 to 2013 (8,335 hospital-year observations). Nurse staffing was measured as full-time equivalents (FTEs) and skill mix. Privatization was defined as conversion from public to either private NFP or private FP status.
FP privatization was associated with greater decreases in registered nurse (RN) staffing FTEs (incidence rate ratio [IRR] = 0.93, p = .004) and total nurse staffing FTEs (IRR = 0.93, p = .001), compared with NFP privatization: RN staffing FTEs (IRR = 0.95, p = .003) and total nurse staffing FTEs (IRR = 0.96, p = .007).
Overall, privatization was associated with decreased RN FTEs and total nurse staffing FTEs and no changes in licensed practical nurse FTEs and RN skill mix.
A close monitoring of nurse staffing level, after privatization, is encouraged to prevent potential deterioration in quality of care.
私有化是公立医院保持竞争力的策略之一。私有化医院可能会实施护士裁员，作为一种节约成本的机制，并提高财务绩效。鉴于私有化与患者和组织结果有关，更好地了解私有化如何影响护士人员配备非常重要。
本研究旨在探讨非营利性 (NFP) 和营利性 (FP) 私有化对护士人员配备的影响。
方法/方法：基于美国医院协会年度调查、医疗保险和医疗补助服务影响文件以及区域卫生资源文件的二次数据集，本研究使用了一种非实验性纵向设计，包括带有医院水平和年份固定效应的负二项式和线性回归模型。我们的样本包括非联邦和非关键通道、急性护理、公立医院（n=492），从 1997 年到 2013 年进行了随访（8335 个医院年观察）。护士人员配备以全职当量 (FTE) 和技能组合衡量。私有化被定义为从公共转为私人 NFP 或私人 FP 状态。
与 NFP 私有化相比，FP 私有化与注册护士 (RN) 人员配备 FTE 减少（发病率比 [IRR] = 0.93，p =.004）和总护士人员配备 FTE 减少（IRR = 0.93，p =.001）相关：RN 人员配备 FTE（IRR = 0.95，p =.003）和总护士人员配备 FTE（IRR = 0.96，p =.007）。
总体而言，私有化与 RN FTE 和总护士人员配备 FTE 减少以及执照实习护士 FTE 和 RN 技能组合没有变化相关。
鼓励在私有化后密切监测护士人员配备水平，以防止护理质量潜在恶化。
