Abstract
BACKGROUND: Inpatient nurse staffing affects patient outcomes. Less is known about the mechanism of this relationship and how lower overall staffing in a unit affects individual RN activities at the bedside. OBJECTIVES: Estimate the relationship between the number of patients assigned to an RN and time spent on medication administration at the peak-time medication pass (PTM), a common nursing task. RESEARCH DESIGN: Estimate the association using multivariable linear regression to adjust for patient severity and staff and unit fixed effects. SUBJECTS: All 9272 RNs administering medications during the PTM on 243 inpatient units in 113 VHA hospitals in 2019. MEASURES: Number of assigned patients to an RN at PTM; PTM duration. RESULTS: After adjusting for staff and unit fixed effects and average patient severity of illness, the PTM duration for an RN assigned 3 patients is 20.67 (95% CI: 20.31, 21.03) minutes longer than when they are assigned 2 patients. The adjusted difference between 4 and 2 patients is 35.42 (95% CI: 35.01, 35.83). PTM duration per patient declines. Relative to 2 patients, RNs assigned 3 patients spend 0.78 (95% CI: 0.63, 0.93) fewer minutes per patient delivering medications during the PTM (3% reduction), and RNs assigned 4 patients spend 2.52 (95% CI: 2.37, 2.68) fewer minutes (11% reduction). CONCLUSION: Individual nurses spend more time overall delivering medications when assigned more patients. Nurses compensate for the increased patient load by only marginally reducing time spent with each patient, even after controlling for patient severity and other factors.