Is there an economic case for investing in nursing care – what does the literature tell us?

Abstract

AimTo determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients?BackgroundResearch has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions.DesignA systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence.Data sourcesThe MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits.Review methodsThe review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes.ResultsFour-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results.ConclusionThis review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies.

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

“…This assessment tallies with a recent extensive review of economic evidence (Twigg et al, 2015). Different answers arise with different cost perspectives.…”

Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda

“…The second strand positions rounding as a strategy to optimize skilled nursing surveillance, and as a vehicle for collaboration and sharing of nursing expertise. Underpinning both of these strands of activity is acknowledgement of the link between the delivery of timely and responsive nursing care and patient safety (Mitchell et al, ; Twigg, Myers, Duffield, Giles, & Evans, ). Attention to investigating the nature and impact of these 2 broad forms of rounding highlight that both basic (Alaloul et al, ; Blakley et al, ) and expert nursing care (Catangui & Slark, ) is linked to patient safety and improved patient outcomes.…”

JAN 40 years on

“…Related to the workforce issue is cost‐effectiveness and cost‐benefit in nursing – something that needs to be addressed urgently – and we already publish excellent papers in this area (Twigg et al . ,b, Schreuders et al . , Yang et al .…”