01.17.2005

Another Study Makes Business Case for Increasing RN Staffing in Hospitals

Better RN Ratios Save Thousands of Lives and Millions of Dollars

CANTON, Mass.—A major study just published in the January/February issue of the journal Health Affairs shows that an “unequivocal business case” can be made for increasing the level of registered nurse staffing in hospitals—a move that could pay for itself in fewer patient deaths, shorter hospital stays, and decreased rates of costly medical complications. Download a PDF copy of the study here.

The study found that if hospitals invested in increased RN staffing at levels comparable to the top 25 percent of the nation’s hospitals, more than 6,700 patient deaths and 4.1 million days of hospital inpatient care could be avoided, with millions of dollars saved each year.

The new study comes at a time when Massachusetts’ policymakers are considering legislation, H. 2663, that would set a safe limit on the number of patients assigned to a nurse at one time. This minimum RN staffing standard is comparable to the staffing levels highlighted in the Health Affairs study.

The Health Affairs report comes just months after the journal Medical Care found minimum RN staffing levels more cost-effective than clot-busting medications for heart attack and stroke, and cervical cancer screenings.

“This is yet another in a long line of recently published studies that clearly demonstrate that improving RN staffing ratios has enormous societal benefits in terms of lives saved and reduced complications, while also being highly cost effective,” said Beth Piknick, president of MNA. “There is no longer any rationale for allowing hospitals to deprive patients of the lifesaving care nurses are capable of providing if and when nurses have a safe number of patients to care for at one time.”

The study was based on data from 800 acute care hospitals across the country. Researchers, led by Jack Needleman, Associate Professor in the School of Public Health at the University of California at Los Angeles, studied several alternative scenarios for improving patient care, and analyzed the cost-benefit of each variation in improved RN staffing.

“From a patient’s perspective…using standard measures of value, the additional costs to increase nurse staffing appear justified,” say the study’s authors.

“Any patient would rightfully be outraged if he or she came into a hospital emergency room and was denied access to life saving clot busting medications; but, every day in Massachusetts patients are being denied the equally effective lifesaving interventions of registered nurses, simply because hospitals refuse to invest in this less expensive preventive measure,” Piknick explained.

According to the new study, the cost of increasing RN staffing levels to provide maximum patient safety benefits represents a mere 1.5 percent increase in hospital costs. However, the authors estimate that hospitals would recoup as much as half of those costs due to savings from improved care over time.

The authors of the new Health Affairs study acknowledge that it fails to account for significant additional cost savings—identified in a number of other studies—that might be realized from reductions in RN turnover and from the avoidance of additional in-stay complications. A number of studies have highlighted the enormous cost of RN turnover driven by poor staffing levels. One such study found that for every dollar invested to reach a 1 to 4 RN-to-patient ratio resulted in $1.20 in savings due to lower RN turnover.

These findings mirror those of a study conducted in 2004 by Andover Economics, Inc., a Massachusetts-based research firm that conducted the only real-time analysis of Massachusetts hospital industry staffing levels and the projected cost to meet requirements of pending RN staffing legislation. This study also pegged the cost of implementing improved RN staffing at between 1.5 and 1.8 percent, depending on the hospital.

In addition to the business case for increased RN staffing levels, the MNA points to the hospital industry’s nearly $1 billion in profits in 2005.

“This and countless other studies confirm that the case for better RN staffing has been made and the time has come to act to ensure that a safe limit is put on the number of patients a nurse is assigned,” Piknick concluded. “Patients are suffering and dying needlessly because hospitals continue to under staff, while reaping ever greater profits each year. It is clear that hospitals will not staff safely until they are required to do so. They need to be held accountable for investing in a safe standard of care.”

###