Impact of a financial incentive policy on Korean nurse staffing

This study was designed to determine (1) the impact of policy on longitudinal changes in nurse staffing levels and (2) the characteristics of policy-responsive Korean hospitals.

A policy of varying nursing fees according to staffing grade by measuring the nurse-to-bed ratio has been implemented in Korean hospitals since 1999 with the aim of satisfying patient care needs and providing safe and high-quality nursing care.

Nurse staffing hospital characteristics data were collected from Korean Hospital Nurses Association yearbooks for the period 1996-2011. The obtained time series nurse staffing data were analysed by assessing the nurse-to-bed ratio. Graphs were used to view nurse staffing trends in various nursing units by hospital type during the study period. Mixed repeated-measures modelling was used to analyse nurse staffing and hospital characteristics, with year categorized as a dummy variable. There were 585 and 1239 observations related to measurements of nurse staffing grade in 44 tertiary and 193 general hospitals, respectively. For measuring the nurse staffing grade in intensive care units, the number of observations for general hospitals was decreased to 1170.

Long-term nurse staffing in general and intensive care units was improved post-policy compared with pre-policy in both tertiary and general hospitals. Nurse staffing was improved more in Seoul than in other areas and was significantly better for hospitals with more beds for both hospital types.

Although the financial incentive policy implemented in Korea has had an overall positive result on nurse staffing, the effect was not assure in small-sized hospitals in rural area. A more refined method for calculating nurse staffing and increasing financial incentives relative to staffing grade is needed to improve hospital nurse staffing.