Impact of nursing policy on securing intensive care unit nurse staffing and in-hospital mortality

Objective: This study aimed to evaluate changes in intensive care unit nurse staffing after the introduction of the government's nursing policy, and the relationship between ICU nurse staffing levels and in-hospital mortality.

Design: A retrospective cohort study.

Setting: This study used data from the Health Insurance Review and Assessment Service and included all patients admitted to adult ICUs at general and tertiary hospitals in Korea from 2016 to 2020.

Methods: The primary variables of interest in this study were the level and overall trend change in the outcome variables after introducing the nursing policy; the nurse-to-bed ratio in the ICUs was evaluated. The secondary variable of interest was the relationship between nurse staffing levels and in-hospital mortality. Interrupted time-series analysis and generalized estimating equation models were used to evaluate the primary and secondary variables of interest.

Results: After the nursing policy was introduced, the nursing grades in the ICUs increased, especially in tertiary hospitals. The change at the time of the introduction of each policy was not statistically significant; however, after the introduction, the number of hospital beds per nurse decreased. In-hospital deaths of patients in ICUs increased as the number of beds per nurse increased (odds ratio [OR]: 1.17, 95 % confidence interval [CI]: 1.12-1.21) and decreased as the number of experienced nurses increased (OR: 0.97, 95 % CI: 0.96-0.98).

Conclusions: The introduction of a nursing policy centered on financial support for medical institutions led to an increase in nurse hiring, leading to improved nursing grades. However, the results of introducing these policies differed by medical institution and region, and disparities between medical institutions appear to have widened further.

Implications for clinical practice: Experienced nurses are important for better outcomes for patients admitted to ICUs, and continuous policy efforts are needed to secure and maintain sufficient nurses.