The association between Doctor of Nursing Practice Nurse Practitioner staffing and hospital outcomes

The National Organization of Nurse Practitioner Faculties advocates for the doctoral level as the entry-to-practice standard for NPs. Understanding the impact of Doctor of Nursing Practice NPs (DNP-NPs) on health care systems is vital for shaping policy, regulations, and practice.

This study quantitatively assesses the relationship between DNP-NP staffing levels and hospital quality and cost outcomes using major datasets.

Data from the 2022 Iowa and Kentucky State Boards of Nursing (BON) and the Centers for Medicaid & Medicare Services (CMS) were used. The BON databases identified DNP-NPs matched to CMS data, with hospital affiliation determined by Hospital CMS Certification Number codes. Doctor of Nursing Practice NP counts were scaled by hospital size, with DNP-NPs per 100 beds as the treatment variable. Outcome variables and hospital characteristics were analyzed by DNP-NP quintiles.

Hospitals in the lowest quintile of DNP-NP staffing had a significantly higher mean readmission rate of 14.84% (SE = 0.245), which was 0.39% points higher ( p = .005) than the adjusted mean of 14.45% (SE = 0.214) for other hospitals. No systematic relationship was found between DNP-NP staffing and readmission rates across the remaining distribution, and no correlation was detected between DNP-NP staffing and other hospital quality or cost efficiency measures.

The study underscores the need for improving data infrastructure to further research the relationship between DNP-NP staffing and hospital quality outcomes and address hospital staffing questions.

Recommendations are provided for enhanced data sources on NP education and practice to inform health care workforce research, staffing, policies, and regulations.