J Korean Clin Nurs Res.  2025 Apr;31(1):35-48. 10.22650/JKCNR.2025.31.1.35.

Changes in Nurse Staffing Grades and Nursing Fee Revenues Based on the Amendment of the Resource-Based Relative Value Scale: Intensive Care Units

• Kim EH
• Cho SH
• Go UR
• Kim JY

• KMID: 2567676
• DOI: http://doi.org/10.22650/JKCNR.2025.31.1.35

Abstract

Purpose
This study aimed to examine changes in nurse staffing grades and nursing fee revenues in intensive care units (ICUs) following the third amendment of the resource-based relative value scale, which was implemented in January 2024.
Methods
Changes in staffing grades from the fourth quarter of 2023 to the first quarter of 2024 were analyzed among 588 general ICUs, 94 neonatal ICUs, and 13 pediatric ICUs. Annual nursing fee revenues per nurse were estimated based on the new nursing fee structure for each grade.
Results
In general ICUs, the highest grade (grade S) and the second-highest grade (grade A) accounted for 7.3% and 41.5%, respectively, in tertiary hospitals, whereas 3.8% were grade S and 11.5% were grade A in general hospitals. In neonatal ICUs, the proportion of higher grades (S, A, and 1) was greater in general hospitals (54.3%) than in tertiary hospitals (38.6%). In pediatric ICUs, 30.8% were grade S and 61.5% were grade A. When applying the same grading criteria (i.e., beds per nurse) across both quarters, staffing levels remained unchanged in most ICUs. Nursing fees and their revenues did not increase proportionally to staffing requirements (i.e., the number of nurses required per patient).
Conclusion
Revisions to staffing grade and nursing fee systems are necessary to induce medical institutions to improve their ICU staffing levels.

Keyword

Intensive Care Units; Nursing Fees; Differentiation; Resource-Based Relative Value Scale; Staffing