Low nurse staffing levels directly linked to higher patient mortality, study finds
- A new study on nurse staffing in BMJ found that the hazard of death increased by 3% for every day a patient experienced nurse staffing levels below England's ward mean. Researchers looked at over 138,000 patient stays in English hospitals between 2012 and 2015.
- Relatively, researchers found that each additional hour of nurse care made available over the first five days of a patient's stay was associated with a 3% reduction in the hazard of death. The study concluded that lower RN staffing combined with higher levels of admissions per RN are associated with an increased risk of hospital mortality.
- Hospitals in England, researchers note, have the some of the lowest nurse-to-patient staffing ratios in Europe due to retention difficulties and government austerity measures, despite laws limiting ratios to roughly eight patients per nurse.
The study, while focusing on England, mirrors long-held concerns shared by many nurses, unions and advocacy organizations in the United States. The research is far from the first of its kind to look at patient safety risks associated with low nurse staffing levels, but it is particularly resonant given recent legislative efforts in the United States to set clear nurse-to-patient staffing levels.
Those efforts have mostly been successfully stymied by the hospital industry — specifically hospital associations and lobbying groups, which have largely outspent campaigns waged by nurse unions and activists. As Massachusetts' failed midterm ballot measure emphasized last month, nurse staffing legislation is often a battle over public perception: One side argues low staffing levels are a public safety risk, especially in intensive care units, while the other side argues that hiring costs associated with ratio mandates are so unmanageable that they'll shutter hospitals.
While corroborating past findings, this particular study also offers some new information on the subject. The research demonstrates a direct association between nurse staffing and patient mortality at the patient level, but also provides depth on staffing variations (RNs, nursing assistants) and outcomes. The researchers also say their data show that the relationship between staffing and mortality is linear, with "no threshold effect over that range of variation."
Short-staffed and burned-out nurses do pose real risks to patient safety, health outcomes and workforce retention in hospitals. A 2017 poll from Kronos Incorporated found 90% of nurses are considering leaving their current hospital for another job. Turnover rates among nurses already costing U.S. hospitals an estimated $9 billion per year.
Nurse turnover, a new Press Ganey paper asserts, is a "systemic issue that must be addressed to protect health care organizations' ability to deliver safe, high quality, patient-centered care." The average cost of turnover for a bedside nurse, according to the report, ranges between $38,000 and $61,100, or $4.4 million and $7 million annually per-hospital.
The pressure is compounded by a looming nurse shortage, an increased need for nurses as they take on a bigger role in patient care and higher acuity severity.
But staffing ratio laws also come with a price tag. The Massachusetts Health Policy Commission estimated earlier this year that November's ballot question would have cost up hospitals in that state up to $949 million a year while generating $47 million in savings related to reducing the "adverse effects" of current laws.
The BMJ study proposes a solution: Researchers found that staffing-related mortality was minimized most when staffing levels were closest to those determined by The Stafford Group's Safer Nursing Care Tool.
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