Hospital Employment Trends in California, 1982-1994

Abstract

During the 1980s California hospitals responded to selective contracting, growth in managed care, and the Medicare prospective payment system (PPS) by controlling their level of spending. This DataWatch examines whether these hospitals achieved these savings by changing the number and/or the mix of hospital employees. We examined employment trends because wages represent the largest component of hospital budgets and because the number and mix of personnel can be changed in the short run. Analysis of the California Health Facilities Cost Report data shows that employment increased steadily during 1982-1994. There is no evidence that hospitals responded to growing competition by altering the rate of growth in hospital personnel and only weak evidence that they altered the mix of personnel by hiring a greater proportion of nonclinical staff. We conclude that increased competition had only a minor effect on hospital employment decisions.

Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply

“…While there has been a great deal of interest in the effect of nurse staffing levels on the quality of care in hospitals, there has been much less interest in determining the factors that affect the nurse staffing levels other than documenting the changes during the health care crisis of the past 15 years (Aiken, Sochalski, and Anderson 1996;Anderson and Kohn 1996;Spetz 1998;Buerhaus and Staiger 1999;Bond and Raehl 2000;Unruh 2002). Recent work has established that the supply of nurses is not meeting the demand for nurses and that this shortage will worsen in the decades to come (U.S. DHHS 2002).…”

Patient Turnover and Nursing Staff Adequacy

“…National and statewide assessments of hospital nurse staffing frequently utilize a measure that averages counts of the number of nurses or hours of nursing care given the number of patients or patient days of care per hospital (Aiken, Sochalski, and Anderson 1996; Anderson and Kohn 1996; Spetz 1998; Buerhaus and Staiger 1999; Kovner, Jones, and Gergen 2000; Unruh 2002). These calculations provide a rough measure of nursing staff resources given patient volume, but they do not consider the intensity of nursing care that must be provided for that patient volume.…”

Licensed Nurse Staffing and Adverse Events in Hospitals

“…All the studies find RN staffing stable or increasing. [11][12][13][14][15][16] However, research examining the relationship between nurse staffing and the quality of care increasingly finds that better RN staffing correlates with higher quality. Initially, only three 17-19 out of eight 17-24 studies found RN staffing to have a statistically significant negative relationship with patient mortality.…”