Studies show higher nurse staffing levels benefit patients

Two studies released in March within a week of each other demonstrate the importance of higher nursing staff levels to patient outcomes, and, indirectly, to managing healthcare costs.

“Nurse Staffing and Inpatient Hospital Mortality” and “Nurse Staffing Effects on Patient Outcomes: Safety-Net and Non–Safety-Net Hospitals” both present evidence that higher nurse staffing levels improve patient outcomes, often saving lives.

“Nurse Staffing and Inpatient Hospital Mortality” by Jack Needleman, et al, was published in The New England Journal of Medicine and found that inadequate staffing of registered nurses (RNs) led to increased mortality rates. The study looked at data from 197,961 admissions and 176,696 nursing shifts in 43 units at an academic medical center.

What’s remarkable about the Needleman study, says Katie Brewer, RN, a senior policy analyst at the American Nurses Association, is that it examines patient outcomes on a unit level. “It’s just a much more precise – direct – link between good staffing, staffing that’s optimal shift by shift, and the patient outcomes that happen on that particular unit,” Brewer says.

What the study also does, indirectly, Brewer points out, is make a strong business case for higher nurse staffing. “You need to see a return on investment,” she says. “When you have better nurse staffing with well trained, confident staff, then your patients are going to get better faster.”

She also notes that as Medicare moves closer to paying for quality rather than fee-for-service, improved patient outcomes will drive higher revenue.

One concrete example of where hospitals lose money by not having adequate nursing staffing, Brewer says, is hospital-acquired conditions, like falls and infections.

The Centers for Medicare and Medicaid Services (CMS) already does not pay for hospital-acquired conditions, and studies like last month’s “Nurse Staffing Effects on Patient Outcomes” indicate that higher nurse staffing levels reduce levels of hospital-acquired conditions, such as infections.

“The fact that CMS will no longer reimburse hospitals for the additional costs of care for hospital-acquired conditions should affect the prioritization of resources used to improve nursing care,” says Mary Blegen, RN, one of the authors of “Nurse Staffing Effects on Patient Outcomes.”

Released in “Medical Care,” Blegen’s study found that higher nursing staff levels in intensive care units (ICU) and non-ICUs improved patient outcomes, with fewer deaths due to congestive heart failure, fewer failure to rescue incidences, lower rates of infection and fewer patients who had to stay in the hospital longer than had been expected.

The study examined data from about 1.1 million adult patient discharges and staffing for almost 900 patient care units from 54 hospitals in the University HealthSystem Consortium.

“Each study that shows new or reinforces previous findings about the effect of nurse staffing on patient outcomes provides further evidence to support planning for strong nurse staffing levels in all types of units in the hospital,” says Blegen.

“Resources are tight in the current economic situation,” she adds. “We hope that research findings like ours will alter the prioritization for the use of those resources.”