On the Association Between Demographic Structural Change and the Effectiveness of Nurse Staffing Policy for Inpatient Care: Evidence from Taiwan

Abstract

Purpose

This study investigates the influence of demographic changes on the effectiveness of hospital nurse staffing policy, measured by the cumulative response of inpatient care quality to adjustments in hospital nurse staffing levels in Taiwan.

Methods

The research design utilized in this study aligns with the observational time-series methodology, and a total of 99 monthly time-series observations were collected from multiple databases administered by the Taiwan government over the period from January 2015 to March 2023. Specifically, the time-varying parameter vector autoregressive and autoregressive distributed lag models were employed to investigate the association between age distribution and nurse staffing policy effectiveness.

Results

The time-varying impulse responses of the unplanned 14-day readmission rate after discharge to changes in nurse staffing levels indicate a positive association between patient-to-nurse ratios and unplanned 14-day readmission rates across various types of hospitals. Nevertheless, the effectiveness of hospitals’ nurse staffing policy is observed to diminish with population aging, particularly evident in medical centers and regional hospitals.

Conclusion

Policymakers should establish lower mandated patient-to-nurse ratios, grounded in practical nurse workforce planning, to address the needs of an aging society and enhance inpatient care quality through improved nurse staffing in hospitals.

Keywords:

• demographic structural change
• nurse staffing
• inpatient care quality
• time-varying parameter vector autoregressive model
• autoregressive distributed lags model

Ethics

The data collection process was approved by the Research Ethics Committee of Taichung Tzu Chi Hospital with the Certificate of Exempt Review ID: REC110-23.

Acknowledgments

This research was funded by the National Science and Technology Council in Taiwan for the research project entitled “Now-casting for the effect of nurse staffing on quality of inpatient care during the COVID-19 pandemic outbreak: Evidence from Taiwan” with Grant No. 110-2410-H-025-012.

Disclosure

The authors report no conflicts of interest in this work.