This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover. Methods: The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. KaplaneMeier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression. Results: The cumulative turnover probability for all nurses was 0.17, 0.29, 0.38, 0.45, and 0.50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant. Conclusions: It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

Aim To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients’ clinical characteristics and indirect nursing activities. Design A cross‐sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. Methods Thirteen experts verified the tools’ content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter‐rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients’ clinical status. Content validity was verified based on the classification results. Using K‐group cluster analysis, score ranges for four groups were identified. Results The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter‐rater reliability showed high agreement.

Many studies have already shown that ensuring proper nurse staffing positively influences the quality of nursing services and patient safety. Countries such as the US, Australia, and Japan have mandated the minimum required level of nursing staffing by law. In South Korea (hereafter Korea), a graded fee system for nursing care-in which different fees are applied depending on the number of patients per nurse-is being implemented. In an attempt to encourage hospitals to employ more nurses, the higher the grade, the higher the fee that is charged for inpatients. For tertiary hospitals, if one nurse takes care of four or more patients, the criteria for the lowest grade-grade six-is satisfied. For the highest grade, grade one, one nurse takes care of less than two patients (Ministry of Health & Welfare, 2017). However, this does not address the number of patients being taken care of by nurses working together in a shift. If the criteria were to be converted to the number of patients per shift, one nurse takes care of approximately 15 patients in grade six, and seven to eight patients in grade one. Given that the criteria for assessing nursing services, such as Korea's grading system, address only the

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Aim This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity. Design This study was conducted using a cross‐sectional study. Methods Three units at one general hospital were investigated. Patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non‐direct nursing time and nursing intensity scores were analysed using descriptive statistics. Results For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2 and 2.9 h for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1 and 2.6 h for Groups 1, 2, 3 and 4, respectively. 5 and 9 additional nurses were needed in the internal medicine and surgical nursing units. Patient Contribution This study confirmed that the optimal number of nurses was not achieved and that the nursing intensity was very high. Long‐term efforts, such as improving the nursing environment, should be made to ensure an optimal number of nurses in various nursing units.