OBJECTIVES: The shortage of general practitioners has become a critical obstacle to improving healthcare quality in many countries. Training and deploying nurse practitioners could help bridge this gap. However, studies utilizing real-world data to evaluate the influence of nurse staffing in developing countries are scarce. This study aimed to explore the impact of hospital nurse staffing on direct medical costs and patient outcomes in China.

METHODS: Nurse staffing data from 2,338 tertiary hospitals were obtained from the China National Database of Nursing Quality (CNDNQ). A 5% random sample of inpatient electronic medical records from these hospitals (2021-2023) was extracted based on inpatient mortality rates from the Hospital Quality Monitoring System (HQMS) database. Log-linear and logistic regression models were used to evaluate the influence of nurse staffing, with coefficients and odds ratios (OR) reported, respectively. Nine control variables were included: age, gender, area, year, primary diagnostic segment type, major surgical operation level, hospital type, severity of condition, and Charlson Comorbidity Index. Subgroup analyses were conducted for patients with malignant neoplasms, respiratory system diseases, circulatory system diseases, and digestive system diseases.

RESULTS: This study included 12,216,142 inpatient admissions in China. An increase in a nurse’s workload by one patient (higher nurse-to-patient ratio) was significantly associated with longer length of stay (β=0.009), increased the likelihood of inpatient in-hospital dying (OR=1.004), lower direct medical costs (β=-0.014), and out-of-pocket cost (β=-0.010). Subgroup analysis revealed that increasing nursing workload was associated with more substantial increases in hospital stays (β=0.022) and in the likelihood of inpatient in-hospital dying (OR=1.040) for patients with malignant neoplasms.

CONCLUSIONS: Strengthening nursing workforce and training clinical nurse specialist, despite increasing healthcare costs to some extent, would be beneficial for improving patient health outcomes. National-level policies to promote appropriate nurse staffing are needed to further improve the quality of care in China.