This research brief estimates the impact of nurse staffing on hospital performance improvement in the Centers for Medicare and Medicaid (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project.

Background

• To date there has been no research on how nurse staffing impacts hospital performance on the type of process quality metrics used in HQID.
• Other research studies and literature reviews on the relationship between nurse staffing levels and hospital quality have yielded inconsistent results on the impact of registered nurse (RN) hours on patient outcomes including adverse events, mortality, and length of stay (LOS), and offered little evidence that licensed practical nurse (LPN) or licensed vocational nurse (LVN) hours had any impact on those issues.

Key Findings

• Increased RN hours per patient day were associated with higher quality.
• Across models, there were no consistent patterns related to the impact of LPN and NA hours on quality.
• The results suggest that RNs affect the care processes that are related to quality outcomes. The research team also acknowledges that many other factors also affect these care processes but that available data did not allow for identification of those factors.