Nurse-staffing level and quality of acute care services:Evidence from cross-national panel data analysis in OECD countries

Background:Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed.Objective:To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run.Data:The number of practicing nurses'density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators(HCQI)included 30-day mortality per 100 patients based on acute myocardial infarction(MORTAMIO),hemorrhagic stroke(MORTHSTO)and ischemic stroke(MORTISTO)were collected as a part of ongoing project by OECD.org in panels of 26 OECD countries over 2005-2015 period.Method:Panel data analysis.Results:There were committed relationships from nurse-staffing level to the enhancement of HCQI i.e.1%increase in nurse-staffing level would reduce the rates of patient mortality based on MORTAMIO,MORTHSTO and MORTISTO by 0.65%,0.60%and 0.80%,respectively.Furthermore,the role of nursestaffing level in increasing overall HCQI were simulated at the highest level in Sweden(-3.53),Denmark(-3.31),Canada(-2.59),Netherlands(-2.33),Finland(-2.09),Switzerland(-1.72),Australia(-1.64)and United States(-1.53).Conclusion:A higher proportion of nurses-staffing level is associated with higher quality of acute care services in OECD countries.Also,the nursing characteristics of Sweden,Denmark,Canada,Netherlands,Finland,Switzerland,Australia and United States would be good patterns for other countries to maximize nursing outcomes in the care of patients with acute and life-threatening conditions by reducing the risk of complication,mortality and adverse clinical outcomes.

Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries

Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.

Nurse staffing and life expectancy at birth and at 65 years old:Evidence from 35 OECD countries

Objective: To measure the possible magnitude of the role nurse staffing has on increasing life expectancy at birth and at 65 years old.Methods: The statistical technique of panel data analysis was applied to investigate the relationship from the number of practicing nurses' density per 1000 population to life expectancy at birth and at 65 years old.Five control variables were used as the proxies for the levels of medical staffing,health care financial and physical resources,and medical technology.The observations of 35 member countries of Organization for Economic Co-operation and Development (OECD) were collected from OECD Health Statistics over 2000-2016 period.Results: There were meaningful relationships from nurse staffing to life expectancy at birth and at 65 years with the long-run elasticities of 0.02 and 0.08,respectively.Overall,the role of nursing characteristics in increasing life expectancy indicators varied among different health care systems of OECD countries and in average were determined at the highest level in Japan (0.25),followed by Iceland (0.24),Belgium (0.21),Czech Republic (0.21),Slovenia (0.20) and Sweden (0.18).Conclusion: A higher proportion of nursing staff is associated with higher life expectancy in OECD countries and the dependency of life expectancy to nursing staff would increase by aging.Hence,the findings of this study warn health policy makers about ignoring the effects nursing shortages create e.g.increasing the risk of actual age-specific mortality,especially in care of elderly people.

Analyzing economic feasibility for investing in nursing care: Evidence from panel data analysis in 35 OECD countries

Objective:To analyze economic feasibility for investing in nursing care.Method:The number of practicing nurses'density per 1000 population as a proxy for nursing staff and Gross Domestic Product(GDP)per capita(current US$)were collected in 35 member countries of Organization for Economic Co-operation and Development(OECD)over 2000-2016 period.The statistical technique of panel data analysis including unit root test,cointegration analysis,Granger causality test,dynamic long-run model analysis and error correction model were applied to measure economic impact of nursing-related services.Results:There was a committed bilateral relationship between nurse-staffing level and GDP with longrun magnitudes of 1.39 and 0A1 for GDP-lead-nurse and nurse-lead-GDP directions in OECD countries,respectively.Moreover,the highest long-run magnitudes of the effect nursing staff has on increasing GDP per capita were calculated in Finland(2.07),Sweden(1.92),Estonia(1.68),Poland(1.52),Czech Republic(1.48),Norway(1.47)and Canada(1.24).Conclusion:Our findings verify that although the dependency of nursing characteristics to GDP per capita is higher than the reliance of GDP to number of nurses'density per 1000 population,investing in nursing care is economically feasible in OECD countries i.e.nursing is not only a financial burden(or cost)on health care systems,but also an economic stimulus in OECD countries.Hence,we alert governments and policy makers about the risk of underestimating the economic impacts of nurses on economic systems of OECD countries.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region:Evidence from daily deaths,infections and needed hospital resources

Objectives:To measure the effect of social distancing on reducing daily deaths,infections and hospital resources needed for coronavirus disease 2019(COVID-19)patients during the first wave of the pandemic in Nordic countries.Methods:The observations of social distancing,daily deaths,infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds,beds needed in ICUs and infection wards,nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation(IHME)by the University of Washington.The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME.The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark,Finland,Iceland,Norway and Sweden.Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.Results:Results of dynamic long-run models confirm that a 1%rise in social distancing by reducing human contacts may decline daily deaths,daily infections,all hospital beds needed,beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%,15.26%,1.10%,1.17%and 1.89%,respectively.Moreover,results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing,the lengths of restoring back to equilibrium are 67,62,40,22 and 49 days for daily deaths,daily infections,all hospital beds needed,nurses/beds needed in ICUs and nurses/beds needed in infection wards,respectively.Conclusion:Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries.The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries

Objectives:To investigate the magnitude of effect nurse staffing had on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development(OECD).Methods:The statistical technique of panel data analysis was applied to explore the possibility of association between the number of nurses'density per 1,000 population and infant,neonatal and perinatal mortality rates(IMR,NMR and PMR)per 1000 births.The observations of 35 OECD countries were collected over the period of 2000 through 2016.Results:There were significant associations between nurse staffing and IMR,NMR and PMR i.e.a 1%increase in nurse-staffing level reduced IMR,NMR and PMR by 0.98%,0.97%and 0.96%,respectively.Furthermore,the role of nursing-related services in declining the average of newborn mortality rates were investigated at the highest level in Slovenia(-5.50),Sweden(-3.34),Iceland(-2.51),Czech Republic(-1.86),Japan(-1.64)and Finland(-1.64).Moreover,if the current relationship between nursestaffing level and newborn mortality rates are disturbed with nursing shortage(e.g.in Slovak Republic and Israel),then it takes about 17 years for the mortality rates to reduce and restore back to the previous equilibrium.Conclusions:A higher proportion of nurses'density per 1,000 population is associated with lower newborn mortality rates.In addition,the nursing-related services of Slovenia,Sweden,Iceland,Czech Republic,Japan and Finland with the highest impact on improving the health level of newborns would be good patterns for other developed countries in maternity and child health care.