Nursing inputs and outcomes of hospital care: an empirical analysis of Ontario's acute-care hospitals

The authors analyze the association between intensity of nursing care (as measured by nursing hours per patient day), hospital bed days, and patient outcomes in acute-care hospitals in the province of Ontario, Canada, to determine whether higher levels of nursing inputs are associated with shorter lengths of stay (LOS) and, if so, whether these shorter LOS are achieved at the expense of health outcomes. After controlling for supply of nurses, workload, community characteristics, and hospital type, the authors found that nursing hours per patient day had a significant negative effect on LOS but had no significant effect on patient satisfaction, hospital mortality, or readmission rates. Further, there was no evidence that shorter than expected LOS were associated with poorer patient health. Such information is relevant for efforts to deploy efficient mixes of health-care resources and to identify future human resource requirements to support the efficient provision of health human resources.