Pai Dinesh R, Bahalkeh Esmaeil
School of Business Administration, Penn State Harrisburg, Middletown, Pennsylvania, USA.
Health Management and Policy Department, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA.
J Rural Health. 2025 Jun;41(3):e70075. doi: 10.1111/jrh.70075.
This study examines the effect of nurse staffing (skill mix and flexibility) on the financial sustainability, efficiency, and quality of care in Pennsylvania's critical access hospitals (CAHs) from 2000 to 2023.
This retrospective longitudinal study utilized unbalanced panel data from Pennsylvania's CAHs (n = 357 hospital-year observations). We employed 2-way fixed effects regression models to analyze the relationship between nurse staffing variables (skill mix and flexibility) and hospital performance outcomes (total margin, cost per adjusted discharge [CPAD], cost per adjusted patient day [CPPD], average length of stay [ALOS], and readmission index). We controlled for hospital-specific, socioeconomic, and demographic factors.
A higher registered nurse (RN) skill mix significantly reduced log(winsorized(CPAD)) (β = -0.495, p<0.01) and log(ALOS) (β = -0.571, p<0.01), indicating improved cost efficiency and patient throughput. Increased nurse flexibility significantly increased log(ALOS) (β = 0.315, p<0.05) but reduced the readmission index (β = -0.895, p<0.01). No significant associations were found between skill mix and total margin, CPPD, or readmission index, nor between flexibility and financial metrics.
A richer RN skill mix enhances efficiency by reducing costs and length of stay, while increased staffing flexibility reduces readmissions but extends ALOS. These findings emphasize the complex interplay between nurse staffing and CAH performance. Strategic management of RN skill mix and flexibility is crucial for optimizing resource use and improving patient outcomes in rural hospitals.
Policymakers and CAH administrators should strategically balance RN expertise and staffing flexibility to ensure both financial viability and clinical excellence in these essential rural health care institutions.
本研究考察了2000年至2023年宾夕法尼亚州急救医院（CAH）的护士配备（技能组合和灵活性）对财务可持续性、效率和护理质量的影响。
这项回顾性纵向研究使用了宾夕法尼亚州CAH的不平衡面板数据（n = 357个医院年度观察值）。我们采用双向固定效应回归模型来分析护士配备变量（技能组合和灵活性）与医院绩效结果（总利润率、调整后出院成本[CPAD]、调整后每日患者成本[CPPD]、平均住院时间[ALOS]和再入院指数）之间的关系。我们控制了医院特定、社会经济和人口因素。
较高的注册护士（RN）技能组合显著降低了log（ Winsorized（CPAD））（β = -0.495，p<0.01）和log（ALOS）（β = -0.571，p<0.01），表明成本效率和患者周转率得到改善。护士灵活性的提高显著增加了log（ALOS）（β = 0.315，p<0.05），但降低了再入院指数（β = -0.895，p<0.01）。在技能组合与总利润率、CPPD或再入院指数之间，以及灵活性与财务指标之间未发现显著关联。
更丰富的RN技能组合通过降低成本和住院时间来提高效率，而增加人员配备灵活性可减少再入院率，但会延长ALOS。这些发现强调了护士配备与CAH绩效之间复杂的相互作用。RN技能组合和灵活性的战略管理对于优化农村医院的资源利用和改善患者结局至关重要。
政策制定者和CAH管理人员应在RN专业知识和人员配备灵活性之间进行战略平衡，以确保这些重要的农村医疗机构在财务上可行且临床卓越。
