Making the Business Case for Hiring More Nurses

How many nurses does it take to provide safe and effective care to patients in a hospital? The answer is as many as it takes.

But to patients what might seem like an easy answer is anything but.

Cost-conscious and profit-minded hospitals want that number as low as possible. Working condition-focused and membership dues-supported nurse unions want that number as high as possible. It’s the classic tug-of-war between competition and regulation with patients stuck in the middle like the little red flag being yanked around over the big mud puddle.  

A new study in The Lancet suggests that patients should be pulling for regulation. You can download the study here. 

Researchers from the nursing schools at the University of Pennsylvania and the Queensland University of Technology in Brisbane, Queensland, in Australia, wanted to know how minimum nurse-to-patient ratios placed by the state of Queensland on hospitals there in 2016 affected clinical outcomes. 

A regulation there required hospitals to staff at least one nurse for every four patients on general adult medical-surgical floors for morning and afternoon shifts and at least one nurse for every seven patients on general adult med-surg floors for night shifts. 

To find out how the new rules affected patient care, the researchers compared outcomes at 27 hospitals subject to the ratios with outcomes at 28 comparable hospitals not subject to the ratios. Outcomes were 30-day patient mortality rates, 7-day patient readmission rates and length of stay. They compared those three outcomes for both pools of hospitals for 2016, when the minimum ratios took effect, with 2018, or two years after the ratios took effect.   

To make a long multilevel and multivariable modeling story short, the researchers found that the new nurse-to-patient ratios had a positive impact on patient care:  

• The 30-day mortality rate went down at the ratio hospitals and went up at the non-ratio hospitals
• The 7-day readmission rate went up slightly at the ratio hospitals and went up by a lot at the non-ratio hospitals
• The average length of stay dropped by a lot at the ratio hospitals and dropped slightly at the non-ratio hospitals

Then the researchers wanted to know whether it was worth it in terms of dollars. They estimated that it cost $33 million Australian dollars to hire more nurses to meet the new minimum staffing requirements over the two-year period. But that cost was more than offset by savings from fewer readmissions ($1.6 million) and fewer hospital days ($67.6 million).

“The results presented here suggest that minimum nurse-to-patient ratio policies are a feasible instrument to improve nurse staffing, produce better patient outcomes, and yield a good return on investment,” the researchers concluded. 

No business likes the government to tell it how to run its business. Hospitals and health system leaders are no different. They don’t want the government let alone nurse unions telling them how many nurses to hire based on their patient load. (They have sophisticated staffing software to tell them that.)

What hospital and health system leaders should focus on in this new study is the business case for hiring more nurses. More nurses equal better care equals lower costs. Isn’t that what it’s all about in a value-based care world?  Better outcomes for less?

Something to think about.

Thanks for reading.