Association of Nurse Work Environment, Staffing, and Skill Mix With Length of Stay for Patients With Intellectual and Developmental Disabilities.

Abstract

Introduction: Complex care for individuals with intellectual and developmental disability (IDD) may translate into longer than needed hospital lengths of stay (LOS). Nurses are poised to influence the outcomes of patients with IDD. But ample evidence suggests that nurses' capacity to provide optimal care may depend on key organizational features such as having sufficient staff, supportive work environments, and sufficient mix of registered nurses, termed nursing resources. This paper aims to determine the association of nursing resource factors with LOS in adults with IDD.

Methods: Linked data from 3 datasets representing 4 states were used. Zero-truncated negative binomial regression models that clustered for patients in the same hospital were used to examine the association between nursing resources and LOS for adults with IDD.

Results: Receiving care in a hospital with a better nurse work environment, skill mix, and staffing was associated with reduced LOS in this sample of 38,587 patients with IDD in 595 hospitals. In univariate models adjusted for hospital and patient characteristics, all 3 nursing resources were independently associated with reduced LOS. In an adjusted multivariate model, work environment and skill mix remained significant with identical effect sizes to the separate models, that is, for an increase of 1 SD, work environment is associated with a reduction in LOS of 2.7% (P=0.005), a 6 day to 5.84 day reduction, and skill mix of 2% (P=0.039), a 6 day to 5.88 day reduction.

Conclusions: The appropriate deployment of nursing resources may lead to a reduction in LOS for patients with IDD.