It’s All in the Numbers: Too Few Nurses Cost Hospitals in Patient Safety

The results are in: Although some have argued that increasing the number of nurses can be costly, not having enough can put patients at risk. A recent study published in the New England Journal of Medicine has provided some answers about how patient mortality is related to low nurse staffing levels. The study supports what many have long believed: 

There is a direct link between risk-adjusted mortality and failure-to-rescue rates and RN staffing ratios.

Nursing advocates are celebrating the study and hoping that the new data will shift the focus within healthcare facilities from costs to patient safety. Earlier studies had also suggested a connection between nurse staffing levels and patient safety, but their conclusions in this regard were unclear.

In short, the study found that when a unit is understaffed, patient mortality rose by 2%. When nurses’ workloads increased during shifts because of high patient turnover, mortality risk also increased. If all three shifts were understaffed, mortality rose by 6%. Each additional patient that was added to a nurse’s workload increased the odds—with a 7% increase in failure-to-rescue, a 23% increase in burnout, and a 15% increase in job dissatisfaction. Burnout and job dissatisfaction predict nurses’ intentions to leave their current jobs within a year. Although it’s not possible to accurately predict how many of these nurses actually did change jobs, when considering published estimates that the cost of replacing a nurse ranges from $42,000 to $64,000 (depending on specialty), improving nurse staffing may not only save patient lives and decrease turnover but also reduce hospital costs.

Adjusting Per Shift

It’s not only a matter of having an adequate number of nurses on staff, but also having enough nurses on each shift that can contribute to adverse events. In another study published in the Journal of Nursing Administration, researchers found that a clear relationship exists between shift nurse staffing and adverse events.

The study analyzed 115,062 consecutive nursing shifts between in medical-surgical units, step-down units, and critical care units and identified a strong relationship between overall staffing and falls with injury. The relationship was most notable with RNs—each 10% decrease in RN care was associated with a 30% increase in the likelihood of falls with injuries in medical-surgical units and a 36% increase in critical care units. A higher percentage of nursing hours per shift was also associated with fewer medication errors in medical-surgical and critical care units.

Although these researchers caution that further research may be needed to be able to specify how nurse workforce characteristics, workload, and specific nursing practices affect patient outcomes, the study recommends that hospitals monitor staffing and outcomes at the shift level to determine the best number and mix of nurses.

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