BACKGROUND: The National Organization of Nurse Practitioner Faculties advocates for the doctoral level as the entry-to-practice standard for NPs. Understanding the impact of Doctor of Nursing Practice NPs (DNP-NPs) on health care systems is vital for shaping policy, regulations, and practice. PURPOSE: This study quantitatively assesses the relationship between DNP-NP staffing levels and hospital quality and cost outcomes using major datasets. METHODOLOGY: Data from the 2022 Iowa and Kentucky State Boards of Nursing (BON) and the Centers for Medicaid & Medicare Services (CMS) were used. The BON databases identified DNP-NPs matched to CMS data, with hospital affiliation determined by Hospital CMS Certification Number codes. Doctor of Nursing Practice NP counts were scaled by hospital size, with DNP-NPs per 100 beds as the treatment variable. Outcome variables and hospital characteristics were analyzed by DNP-NP quintiles. RESULTS: Hospitals in the lowest quintile of DNP-NP staffing had a significantly higher mean readmission rate of 14.84% (SE = 0.245), which was 0.39% points higher (p = .005) than the adjusted mean of 14.45% (SE = 0.214) for other hospitals. No systematic relationship was found between DNP-NP staffing and readmission rates across the remaining distribution, and no correlation was detected between DNP-NP staffing and other hospital quality or cost efficiency measures. CONCLUSION: The study underscores the need for improving data infrastructure to further research the relationship between DNP-NP staffing and hospital quality outcomes and address hospital staffing questions. IMPLICATIONS: Recommendations are provided for enhanced data sources on NP education and practice to inform health care workforce research, staffing, policies, and regulations.
