The Impact of Market Conditions on RN Staffing in Hospitals: Using Resource Dependence Theory and Information Uncertainty Perspective

Figures & data

Table 1 Summary of Variables

Variable	Definition	Data Source
Dependent Variable
RN Staffing
RN staffing intensity	RN FTEs/(Inpatient days/1,000)	AHA
RN to non-RN ratio	RN FTEs/(LPN and nursing aides FTEs)	AHA
Independent Variable
Environment Factors
Munificence
Per capita income	Mean income within county	AHRF
Urban location	Location in urban areas (1: yes, 0: no)	AHA
Specialist resource	# of physician specialists per 1,000 capita	AHRF
Dynamism
Medicare HMO penetration	Medicare HMO enrollment as percent of total Medicare population in a county	AHRF
Change in unemployment rate	Yearly change in county unemployment rate	LAUS
Complexity
HHI	The sum of squared market share of all hospitals in HSA	AHA
Control Variable
Bed size	The number of staffed inpatient beds	AHA
System affiliation	Status of a hospital’s membership in multihospital systems (1: system hospital, 0: non-system hospital)	AHA
Ownership	Status of a hospital as a for-profit, not-for-profit private, or public entity (1: for-profit, 2: not-for-profit private, 3: public)	AHA
Teaching status	Existence of approved medical residency programs, affiliation with medical school or COTH membership (1: yes, 0: no)	AHA
Occupancy rate	Total inpatient days/number of staffed beds*365	AHA
Case mix index*	Level of complexity in Medicare cases	CMI File
Magnet status	Magnet Hospital credentialing (1:yes, 0: no)	Magnet Hospital
LPN staffing intensity	LPN FTEs/(Inpatient days/1,000)	AHA

Note: *Missing values were imputed by the Gaussian normal regression imputation method software (StataCorp., 2013) because of the large number of missing cases in the CMI data (28.4%).⁴³

Table 2 Descriptive Statistics

Variable	Hospital/Years	Mean/Frequency (%)	SD
Dependent Variables
RN staffing intensity	21,264	7.22	4.05
RN to non-RN ratio	20,856	2.67	1.64
Independent Variables
Environment factors
Munificence
Per capita income ($1,000)	21,264	35.15	9.16
Specialist resources (per 1,000)	21,264	1.49	1.28
Urban location	21,264
Urban		14,344(67.5%)
Rural		6,920(32.5%)
Dynamism
Medicare HMO penetration	21,264	0.17	0.13
Change in unemployment rate	21,264	0.15	0.28
Complexity
HHI	21,264	0.77	0.32
Control variables
Bed	21,264	164.00	164.93
System affiliation	21,264
Affiliated		11,737(55.2%)	-
Not-affiliated		9,527(44.8%)	-
Ownership	21,264
For-profit		3,401(16.0%)	-
Not-for-profit, private		12,942(60.9%)	-
Not-for-profit, public (non-federal)		4,921(23.1%)	-
Teaching status	21,264
Teaching hospital		4,918(23.1%)	-
Non-teaching hospital		16,346(76.9%)	-
Occupancy rate	21,264	0.56	0.19
CMI	15,216	1.37	0.27
Magnet hospital status	21,264
Magnet hospital		950(4.5%)	-
Non-magnet hospital		20,314(95.5%)	-
LPN staffing intensity	21,264	1.18	1.36

Table 3 Mean Difference of Variables Between 2006 and 2010

	2006		2010
Variable	Mean	SD	Mean	SD	P-value
RN staffing intensity	6.544	3.550	7.956	4.362	0.000
RN to non-RN ratio	2.508	1.562	2.858	1.698	0.000
Per capita incomes ($1,000)	32.375	8.865	36.492	8.600	0.000
Specialist resources (per 1,000)	1.445	1.217	1.516	1.329	0.000
Medicare HMO penetration	0.140	0.123	0.205	0.137	0.000
Change in unemployment rate	−0.092	0.087	0.033	0.088	0.000
HHI	0.780	0.315	0.782	0.312	0.040
Bed	167.168	163.207	168.120	168.295	0.157
Occupancy rate	0.575	0.184	0.543	0.185	0.000
CMI	1.347	0.254	1.401	0.271	0.000
LPN staffing intensity	1.160	1.245	1.160	1.454	0.983

Table 4 The Relationship Between Contextual Factors and RN Staffing Levels

	RN Staffing Intensity		RN to Non-RN Ratio
	Coef.	Std. Err.	Coef.	Std. Err.
Per capita income	0.003***	0.000	0.004***	0.001
Urban location	0.149***	0.011	0.176***	0.015
Specialist resources	0.018***	0.004	0.011*	0.006
Medicare HMO penetration	0.022	0.030	0.215***	0.047
Change in unemployment rate	0.002	0.006	0.005	0.012
HHI	−0.051***	0.012	−0.045*	0.017
Bed	−0.002***	0.000	0.000***	0.000
Square bed	0.000***	0.000	−0.000***	0.000
System affiliation	0.013*	0.006	0.058***	0.009
Ownership (reference: for-profit)
Not-for-profit private	0.043***	0.010	0.051***	0.014
Public	−0.008	0.013	−0.078***	0.018
Teaching status	0.074***	0.007	0.019*	0.010
Occupancy rate	−0.881***	0.022	−0.252***	0.025
CMI	0.214***	0.014	0.212***	0.024
Magnet hospital status	0.059***	0.008	0.041*	0.016
LPN staffing intensity	0.052***	0.004	-	-
Year (reference: 2006)
2007	0.046***	0.002	0.059***	0.005
2008	0.087***	0.004	0.100***	0.007
2009	0.107***	0.005	0.090***	0.010
2010	0.070***	0.004	0.118***	0.007
F	99.70***		75.34***

Notes: *p < 0.05; ***p < 0.001.

StataCorp. Stata: Release 13. Statistical Software. College Station, TX: StataCorp LP; 2013.

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