Improving hospital nurse staffing as proposed in pending legislation in New York State would likely save lives, according to a new study published in Medical Care, and the cost of improving nurse staffing would be offset by savings achieved through reducing hospital readmissions and length of hospital stays.
Researchers at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing conducted independent research in early 2020 on whether pending nurse staffing legislation in New York State is in the public's interest.
The analysis of 116 hospitals and 418,000 Medicare patients documented large differences in patient-to-nurse ratios by hospital, from an average of 4.3 patients for each nurse to as many as 10.5 patients per nurse.
WHAT'S THE IMPACT?
The wide variation in patient-to-nurse ratios across hospitals in New York is contributing to avoidable deaths and unnecessary costs, according to the study. Improving nurse staffing would likely reduce deaths and save money, which could in turn then be used to fund staffing.
Hospital deaths and costs of care are significantly lower in hospitals with better nurse staffing, results showed. Each additional patient added to a nurse's workload is associated with 13% higher in-hospital mortality and 8% higher readmissions. Similarly, the odds of staying a day longer in the hospital, a major cost factor, increased by 9% for surgical patients and 5% for medical patients.
If all New York hospitals had staffed at levels recommended in the pending legislation of not more than four patients per nurse on medical and surgical units, more than 4,370 deaths could have been avoided over a two-year period and over $720 million saved among Medicare patients alone, and likely considerably more across all hospitalized patients.
Part of the savings comes from better care, which results in avoided days of care and thus significant savings – suggesting that better staffing ratios are in the public interest.
THE LARGER TREND
Hospital executives in February said they were experiencing a nursing shortage due to several reasons, including the possibility that nurses could get $150 an hour as a travelling nurse versus $48 an hour on hospital staff.
Nurses are simply tired, said Judy Rich, president and CEO, Tucson Medical Center, Tucson in Arizona. Tucson Medical Center had 94 deaths in January.
In other cases, nurses had to choose between work and having children at home while schools were not holding in-person sessions. Some nurses who were close to retirement chose to leave, while others left for work outside of acute care settings.