Author Type

Graduate Student

Date of Award

Summer 7-15-2026

Document Type

Dissertation

Publication Status

Version of Record

Submission Date

July 2026

Department

Management Programs

College Granting Degree

College of Business

Department Granting Degree

Management Programs

Degree Name

Doctor of Philosophy (PhD)

Thesis/Dissertation Advisor [Chair]

Scott Feyereisen

Abstract

Nurse staffing is strongly associated with organizational and patient quality outcomes. Existing studies have not adequately explained why nurse staffing levels vary across hospitals operating under similar external institutional isomorphic pressures. Secondary and administrative datasets, along with random-effects regression models, were used to analyze 6 years of data (2014-2019) and examine the relationship between institutional factors and hospital nurse staffing in the general acute care setting. The results indicate that coercive factors of state laws were significantly associated with nurse staffing. Staffing mandates and staffing committees were significantly associated with increases in nurse staffing, while public reporting was significantly associated with decreases in nurse staffing. Normative factors, including accreditation and teaching status, had a weaker, primarily non-significant association with nurse staffing. The normative factor of nursing autonomy, measured as a proxy for APRN state-sanctioned autonomy, was significant and negatively associated with nurse staffing. Mimetic factors, including bed size, were significantly associated with higher nurse staffing, whereas high market concentration was significantly associated with lower nurse staffing. The findings of this study, which examine nurse staffing through the lens of institutional isomorphism, provide insights into how external pressures shape organizational behavior and nurse staffing within hospitals.

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