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The relationship between nurse staffing levels and objective and subjective quality of care: A panel data approach for Germany


  • Augurzky, Boris
  • Bünnings, Christian
  • Wübker, Ansgar


In this study we investigate the relationship between nursing staffing levels and hospital quality in Germany. We use administrative data from almost all German hospitals from 2002 to 2013 and link it to mortality rates and patient satisfaction measures. To analyze the association between nursing staffing levels and hospital quality indicators empirically, we estimate linear regression models and control for a wide range of hospital and patient characteristics that might bias the results. In addition, we exploit the longitudinal structure of the data and rule out potential bias due to time-invariant unobserved heterogeneity. The estimation results indicate a positive relationship between nurse staffing levels and hospital quality for both subjective and objective quality measures. Increasing nurse staffing levels by 10 percent reduces the mortality rate by 0.05 percent and increases patient satisfaction by around 0.7 percent, on average. Although we find some of these relationships to be statistically significant, at least marginally, the absolute magnitudes of the estimated coefficients are rather small.

Suggested Citation

  • Augurzky, Boris & Bünnings, Christian & Wübker, Ansgar, 2017. "The relationship between nurse staffing levels and objective and subjective quality of care: A panel data approach for Germany," Ruhr Economic Papers 724, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
  • Handle: RePEc:zbw:rwirep:724

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    References listed on IDEAS

    1. Cook, Andrew & Gaynor, Martin & Stephens Jr, Melvin & Taylor, Lowell, 2012. "The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California's minimum staffing regulation," Journal of Health Economics, Elsevier, vol. 31(2), pages 340-348.
    2. Augurzky, Boris & Bünnings, Christian & Dördelmann, Sandra & Greiner, Wolfgang & Hein, Lorenz & Scholz, Stefan & Wübker, Ansgar, 2016. "Die Zukunft der Pflege im Krankenhaus: Forschungsprojekt im Auftrag der Techniker Krankenkasse," RWI Materialien 104, RWI - Leibniz-Institut für Wirtschaftsforschung.
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    More about this item


    Hospital quality; nurse staffing; patient satisfaction; mortality rate;

    JEL classification:

    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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