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

Area of Science:

• Health Services Research
• Nursing Administration
• Rural Health Policy

Background:

• Critical Access Hospitals (CAHs) are vital for rural healthcare access.
• Nurse staffing models significantly influence hospital operations and patient outcomes.
• Understanding the impact of nurse skill mix and flexibility is crucial for CAH sustainability.

Purpose of the Study:

• To analyze the effect of nurse staffing (skill mix and flexibility) on financial sustainability, efficiency, and quality of care in Pennsylvania's CAHs.
• To provide data-driven insights for optimizing nurse staffing strategies in rural hospitals.

Main Methods:

• Retrospective longitudinal study using unbalanced panel data from 357 Pennsylvania CAHs (2000-2023).
• Employed 2-way fixed effects regression models to assess nurse staffing variables against hospital performance metrics.
• Controlled for hospital-specific, socioeconomic, and demographic factors.

Main Results:

• Higher registered nurse (RN) skill mix significantly reduced cost per adjusted discharge (CPAD) and average length of stay (ALOS).
• Increased nurse flexibility significantly reduced the readmission index but increased ALOS.
• No significant associations were found between skill mix and total margin, cost per adjusted patient day (CPPD), or readmission index, nor between flexibility and financial metrics.

Conclusions:

• A richer RN skill mix enhances efficiency by reducing costs and length of stay.
• Increased staffing flexibility improves quality by reducing readmissions but may extend ALOS.
• Strategic management of RN skill mix and flexibility is essential for optimizing resource use and improving patient outcomes in CAHs.