Suboptimal Nurse Staffing Ratios Tied to Adverse Patient Safety Events

Healthcare organizations with suboptimal nurse staffing ratios are more likely to see higher mortality rates and longer hospital stays, two key adverse patient safety events that can also cost healthcare organizations money.

The data, published in BMJ Open, specifically found that for every one-patient increase in nurse workloads, organizations see a 16 percent increase in the mortality rate and a 5 percent increase in odds of a patient staying an extra day in the hospital.

This comes as the medical industry debates nurse staffing ratios and how to enforce them. In Illinois, HB 2604 Nurse Staffing Limits Act sets a minimum nurse staffing ratio. The bill would set that minimum to no more than four patients assigned to a single nurse at a given time.

Proponents of the bill said this latest study, conducted by the Center for Health Outcomes and Policy Research and the University of Pennsylvania School of Nursing, gives credence to the proposed legislation.

“This independent scientific study shows that setting a quality standard for nurse staffing in hospitals is in the public’s interest,” Linda H. Aiken, PhD, RN, the founding director of the Center for Health Outcomes and Policy research, a Penn professor, and the study’s co-author, said in a public statement. “And there are plenty of nurses to take good jobs in hospitals with the nation’s nursing schools producing an all-time high of over 180,000 new nurses every year.” 

The study uncovered significant variation in nurse staffing ratios across the state, the authors continued. The assessment of 87 hospitals and 210,000 hospitalized patients showed some hospitals maintain an average nurse staffing ratio of 5.4 patients per nurse; for others, the ratio is as large as 7.6 patients per nurse.

These larger nurse staffing ratios, and the variation across the state, can result in adverse patient safety events and higher hospital costs due to longer hospital stays, the study authors pointed out in support of HB 2604.

“The pending legislation would improve nurse staffing in Illinois hospitals, and likely save lives and avoid longer and more costly hospital stays,” Karen Lasater, PhD, RN, an assistant professor and researcher at Penn, and the study’s lead author, said in the press release.

All said, the study estimated the proposed legislation could save lives and cut costs annually. If nurse staffing ratios were set and enforced at four patients per nurse, Illinois hospitals would see 1,595 fewer patient deaths and more than $117 million in cost savings annually. Those figures are among Medicare patients alone, the researchers pointed out.

Legislation mandating minimum nurse staffing ratios does garner public support, with a 2020 Harris Poll showing that 91 percent of the public can get behind this kind of legislation.

But the pandemic has changed the face of clinician staffing. Previous to the COVID-19 outbreak, the primary argument against nurse staffing ratios was the cost of hiring more nurses and whether organizations could effectively recruit enough nurses to support those ratios.

The Great Resignation has hit healthcare, with nurse staffing turnover particularly high. In October, NSI Nursing Solutions, Inc., reported that nurse staffing turnover was at an all-time high of 2.8 percent, causing the overall turnover rate to rise to 18.7 percent. In total, that nurse staffing turnover is costing healthcare $6.5 million annually and it poses a risk to patient safety.

Those patient safety complications do corroborate the Penn Nursing study, suggesting that more nurses could improve patient safety. However, given the current climate of clinician, and particularly nurse staffing shortages, it could be difficult for healthcare organizations to actually fulfill a minimum standard for nurse staffing ratios.