Skill mix versus flexibility: Decoding nurse staffing impacts on critical access hospitals

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-08-28 DOI:10.1111/jrh.70075

Dinesh R. Pai PhD, Esmaeil Bahalkeh PhD

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引用次数: 0

Abstract

Objective

This study examines the effect of nurse staffing (skill mix and flexibility) on the financial sustainability, efficiency, and quality of care in Pennsylvania's critical access hospitals (CAHs) from 2000 to 2023.

Methods

This retrospective longitudinal study utilized unbalanced panel data from Pennsylvania's CAHs (n = 357 hospital-year observations). We employed 2-way fixed effects regression models to analyze the relationship between nurse staffing variables (skill mix and flexibility) and hospital performance outcomes (total margin, cost per adjusted discharge [CPAD], cost per adjusted patient day [CPPD], average length of stay [ALOS], and readmission index). We controlled for hospital-specific, socioeconomic, and demographic factors.

Results

A higher registered nurse (RN) skill mix significantly reduced log(winsorized(CPAD)) (β = −0.495, p<0.01) and log(ALOS) (β = −0.571, p<0.01), indicating improved cost efficiency and patient throughput. Increased nurse flexibility significantly increased log(ALOS) (β = 0.315, p<0.05) but reduced the readmission index (β = −0.895, p<0.01). No significant associations were found between skill mix and total margin, CPPD, or readmission index, nor between flexibility and financial metrics.

Discussion

A richer RN skill mix enhances efficiency by reducing costs and length of stay, while increased staffing flexibility reduces readmissions but extends ALOS. These findings emphasize the complex interplay between nurse staffing and CAH performance. Strategic management of RN skill mix and flexibility is crucial for optimizing resource use and improving patient outcomes in rural hospitals.

Conclusions

Policymakers and CAH administrators should strategically balance RN expertise and staffing flexibility to ensure both financial viability and clinical excellence in these essential rural health care institutions.

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技能组合与灵活性：解码护士人员配置对关键医院的影响

目的：本研究探讨2000年至2023年宾夕法尼亚州关键医院（CAHs）护士人员配置（技能组合和灵活性）对财务可持续性、效率和护理质量的影响。方法本回顾性纵向研究利用来自宾夕法尼亚州CAHs的非平衡面板数据（n = 357个医院年观察）。我们采用双向固定效应回归模型分析护士人员配置变量（技能组合和灵活性）与医院绩效结果（总利润、每次调整出院成本（CPAD）、每次调整病人日成本（CPPD）、平均住院时间（ALOS）和再入院指数）之间的关系。我们控制了医院特定因素、社会经济因素和人口因素。结果较高的注册护士（RN）技能组合显著降低了log(winsorized， CPAD) （β = - 0.495, p<0.01）和log(ALOS) (β = - 0.571, p<0.01)，提高了成本效率和患者吞吐量。增加护士灵活性可显著提高log(ALOS) (β = 0.315, p<0.05)，降低再入院指数（β = - 0.895, p<0.01）。没有发现技能组合与总边际、CPPD或再入院指数之间的显著关联，也没有发现灵活性和财务指标之间的显著关联。更丰富的注册护士技能组合通过减少成本和住院时间来提高效率，而增加的人员灵活性减少了再入院，但延长了ALOS。这些发现强调了护士人员配置与CAH绩效之间复杂的相互作用。战略管理护士的技能组合和灵活性是优化资源利用和改善农村医院病人的结果至关重要。结论决策者和CAH管理者应在战略上平衡注册护士专业知识和人员配置灵活性，以确保这些基本农村卫生保健机构的财务可行性和临床卓越性。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.