Were hospital financial resources associated with nurse staffing levels before and during COVID-19?

Document Type

Journal Article

Publication Date

10-29-2025

Journal

Nursing outlook

Volume

73

Issue

6

DOI

10.1016/j.outlook.2025.102573

Keywords

COVID-19; Health workforce; Hospital financing; Hospital spending; Nurse staffing

Abstract

BACKGROUND: Policymaker tend to assume that the problem of low nurse staffing is a result of hospitals financial contraints. PURPOSE: This study explores whether higher hospital resource levels were associated with higher nurse staffing before (2019) and then during (2020-2022) the COVID-19 pandemic, a period of increased funding to most U.S. hospitals. METHODS: We used Premier Inc.'s OperationsAdvisor database and the PINC AI Healthcare Database to explore this question in a sample of 78 hospitals. We measured resources using both (a) current ratio (assets to liabilities) and (b) days cash on hand, and our main outcome measure was nurse hours per patient day (NHPPD), including agency and overtime nurse hours. We employed a multivariate random-effects model with time interactions with the financial variables. FINDINGS: We found that in the pre-COVID period, there was no association between hospital financial resources and nurse staffing. During the first two periods of the pandemic, despite the overall staffing increase in the first wave, we observed an inverse association between hospitals' current ratio and NHPPD. CONCLUSION: Thus, even with the surge in government subsidies during the pandemic, greater resources were not associated with higher nurse staffing.

Department

Health Policy and Management

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