TY - JOUR
T1 - Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels
AU - Li, Suhui
AU - Pittman, Patricia
AU - Han, Xinxin
AU - Lowe, Timothy John
N1 - Publisher Copyright:
© Health Research and Educational Trust
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Objective: This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs). Data Source: We used 5 years of data (2010–2014) from an operational database maintained by Premier, Inc. that tracks labor hours, hospital units, and facility characteristics. Study Design: We assessed changes over time in the average number of total hours worked by RNs, LPNs, and CNLP, adjusted by total patient days. We then conducted linear regressions to estimate the relationships between nurse and CNLP staffing, controlling for patient acuity, volume, and hospital fixed effects. Principal Findings: The overall use of CNLP and LPN hours per patient day declined from 2010 to 2014, while RN hours per patient day remained stable. We found no evidence of substitution between CNLP and nurses during the study period: Nurse-related CNLP hours were positively associated with RN hours and not significantly related to LPN hours, holding other factors constant. Conclusions: Findings point to the importance of examining where and why CNLP hours per patient day have declined and to understanding of the effects of these changes on outcomes.
AB - Objective: This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs). Data Source: We used 5 years of data (2010–2014) from an operational database maintained by Premier, Inc. that tracks labor hours, hospital units, and facility characteristics. Study Design: We assessed changes over time in the average number of total hours worked by RNs, LPNs, and CNLP, adjusted by total patient days. We then conducted linear regressions to estimate the relationships between nurse and CNLP staffing, controlling for patient acuity, volume, and hospital fixed effects. Principal Findings: The overall use of CNLP and LPN hours per patient day declined from 2010 to 2014, while RN hours per patient day remained stable. We found no evidence of substitution between CNLP and nurses during the study period: Nurse-related CNLP hours were positively associated with RN hours and not significantly related to LPN hours, holding other factors constant. Conclusions: Findings point to the importance of examining where and why CNLP hours per patient day have declined and to understanding of the effects of these changes on outcomes.
KW - Health care workforce
KW - clinical nonlicensed personnel
KW - nurse staffing
KW - substitution
KW - unlicensed assistive personnel
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U2 - 10.1111/1475-6773.12655
DO - 10.1111/1475-6773.12655
M3 - Article
C2 - 28127771
AN - SCOPUS:85010840257
SN - 0017-9124
VL - 52
SP - 422
EP - 436
JO - Health services research
JF - Health services research
ER -