Is Hospital Nurse Staffing Legislation in the Public’s Interest?

Lasater, Karen B.; Aiken, Linda H.; Sloane, Douglas M.; French, Rachel; Anusiewicz, Colleen V.; Martin, Brendan; Reneau, Kyrani; Alexander, Maryann; McHugh, Matthew D.

doi:10.1097/mlr.0000000000001519

Cited by 41 publications

(44 citation statements)

References 24 publications

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“…Hospitals would have collectively saved over $117 million annually from length of stay reductions just among Medicare patients-cost savings which could be reinvested into financing safer nurse staffing ratios. These findings are consistent with other research conducted in New York hospitals 32 and internationally 33 34 which show that patients in hospitals with better nurse staffing have shorter lengths of stay as well as fewer readmissions, both of which translate to avoided costs. Studies conducted in Queensland Australia and Chile demonstrate that the magnitude of the cost savings associated with better nurse staffing were in excess of the costs of hiring more nurses; 33 34 a Open access illustration of the value proposition for increasing nurse staffing.…”

Section: Discussionsupporting

confidence: 91%

“…For example, an analysis of hospital nurse staffing among New York hospitals found that if hospitals staffed medical–surgical units with four patients per nurse, as opposed to the average hospital ratio of 6.3 patients per nurse, then thousands of deaths could have been avoided and many hundreds of millions of dollars saved through shorter lengths of stay and avoided readmissions. 21 The same study 22 showed that improving nurse staffing in New York hospitals would have reduced deaths among sepsis patients more than a policy passed earlier that mandated adherence to a standardised set of services for sepsis patients. A study of adult medical patients showed that patients in hospitals with better nurse resources had better outcomes including less mortality, fewer readmissions and shorter lengths of stay—at no difference in cost, when compared with similar patients in hospitals with poorer resources.…”

Section: Introductionmentioning

confidence: 99%

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Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

et al. 2021

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ObjectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.DesignCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.Participants210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital.Main outcome measuresPrimary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.ResultsPatient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse’s workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse’s workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.ConclusionsPatient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical–surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

et al. 2021

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“…Researchers have also identified that increasing the proportion of RNs, as opposed to increasing RN work hours, acquires less cost to hospitals ($811 vs. $7,538 million) 40 . Similarly, more recent research has shown that if medical‐surgical units in New York hospitals maintained nurse‐to‐patient ratios of 1:4 (as opposed to the average of 1:6), hospitals could have saved $720 million over 2 years due to decreases in hospital readmissions and shorter patient length‐of‐stays 79 …”

Section: Stakeholder Analysismentioning

confidence: 99%

“…Although, publicly owned hospitals with a high reliance on Medicaid funding could require increased state Medicaid reimbursements after policy implementation 97 . This policy option could be considered the costliest option in terms of labor expsenses, 94,97 but it should also be noted that this is the only policy option associated with reductions of hospital costs in the long term through decreasing adverse patient events, readmissions, and length‐of‐stays 36,75–77,79 …”

Section: Policy Option Analysismentioning

confidence: 99%

Nurse staffing legislation: Empirical evidence and policy analysis

2021

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Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient‐centric lens, three state‐level nurse staffing policies (mandated nurse‐to‐patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

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“…There is a growing body of evidence that there is a link between nursing staffing, nurse education and in-hospital mortality [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. One of the most extensive studies conducted in nine European countries produced high-quality evidence on the impact of nursing hours per patient per day (NHpPD) and the level of nursing education on the incidence of adverse events, complications and in-hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Improving Nurses’ Education Level in the Context of In-Hospital Mortality

Wieczorek-Wójcik

Gaworska‐Krzemińska

Szynkiewicz

et al. 2022

IJERPH

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(1) Background: an assessment of the cost-effectiveness of employing an increased number of nurses with higher education from the perspective of the service provider. (2) Methods: Based on a year-long study results and data collected from a large hospital, we conducted of the costs of preventing one death. The study involved intervention by 10% increase in the percentage of nursing care hours provided by nurses with higher education. The measure of health effects was the cost of avoiding one death (CER). The cost-effectiveness analysis (CEA) was used as the evaluation method. (3) Results: The cost of employing a larger percentage of nurses with higher education amounts to a total of amounts to a USD 11,730.62 an increase of 3.02% as compared to the base costs. The estimated number of deaths that could be prevented was 44 deaths. Mortality per 1000 patient days was 9.42, mortality after intervention was 8.41. The cost of preventing one death by the 10% increase in BSN/MSN NCH percentage in non-surgical wards USD 263.92. (4) Conclusions: increasing the percentage of care hours provided by nurses with tertiary education is a cost-effective method of reducing in-hospital mortality.

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Is Hospital Nurse Staffing Legislation in the Public’s Interest?

Abstract: Supplemental Digital Content is available in the text.

Cited by 41 publications

References 24 publications

Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

Nurse staffing legislation: Empirical evidence and policy analysis

Cost-Effectiveness Analysis of Improving Nurses’ Education Level in the Context of In-Hospital Mortality

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