- Cost to replace a single nurse burned out by overwork from understaffing was in excess of $80,000/nurse in 2012 (Twibell & St. Pierre, 2012).
- The difference between 4:1 and 8:1 patient-to-nurse staffing ratios is approximately 1,000 patient deaths (Aiken, Clarke, Sloan et al., 2002).
- Patients on understaffed nursing units have a 6% higher mortality rate (Needleman et al., 2011). This risk is higher within the first 5 days of admission (Needleman et al).
- An increase of one RN FTE per 1000 patient days has been associated with a statistically significant 4.3% reduction in patient mortality (Harless & Mark, 2010).
- Adding one patient to a nurse’s workload increases the odds for readmission for heart attack by 9%, for heart failure by 7%, and for pneumonia by 6% (McHugh, 2013).
- Lower patient-to-nurse staffing ratios have been significantly associated with lower rates of:
- Hospital mortality;
- Failure to rescue;
- Cardiac arrest;
- Hospital-acquired pneumonia
- Respiratory failure;
- Patient falls (with and without injury); and
- Pressure ulcers (Aiken, Sloane, et al., 2011; Cho et al., 2015; Kane et al., 2007; Needleman, Buerhaus, Stewart, Zelevinsky & Mattke, 2006; Rafferty et al., 2007: Stalpers et al., 2015)
- Higher numbers of patients per nurse was strongly associated with administration of the wrong medication or dose, pressure ulcers, and patient falls with injury (Cho, Chin, Kim, & Hong, 2016).
- Rising patient volumes, higher patient acuity, and reduced resources lead to nurse burnout and fatigue, resulting in first year nurse turnover rates of approximately 30% and second year rates up to 57% (Twibell & St. Pierre, 2012).
So, based on the estimated replacement costs cited in #1, if a hospital hired 100 nurses in a 12-month period and 30% of them quit, replacing those nurses would cost the facility $2,400,000!
Ruth Neese, PhD, RN, CEN February 16, 2016
REFERENCES:
The odds of failure to rescue and of death for postsurgical black patients increased by 1.10 for each additional patient per nurse.
Carthon, J.M., Kutney-Lee, A., Jarrin, O., Sloane, D., & Aiken, L. (2012). Nurse staffing and postsurgical outcomes in black patients. Journal of the American Geriatric Society, 60 (6), 1078-1084. doi: 10.1111/j.1532-5415.2012.03990x
The better the nursing work environment, the fewer medical errors.
Cho, E., Chin, D., Kim, S., & Hong, O. (2016) The relationship of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48 (1), 74-82. doi: 10.1111/jnu.12183
More patients per nurse associated with a greater risk of patient falls with injury and medication errors.
Cho, E., Chin, D., Kim, S., & Hong, O. (2016) The relationship of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48 (1), 74-82. doi: 10.1111/jnu.12183
Hospitals that reduced nurse burnout by 30% had a total of 6239 fewer UTIs and SSIs, for an annual cost saving of up to $68 million.
Cimiotti, J., Aiken, L., Sloane, D., & Wu, E. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40 (6), 486-490. doi: 10.1016/j.ajic.2012.02.029
Higher nurse staffing levels prevent ICU readmission/return to OR in less severely ill post-operative cardiac surgical patients. Higher nurse staffing levels were also associated with lower inpatient mortality in post-operative cardiac surgical patients.
Diya, L., Van Den Heede, K., Sermeus, W., & Lesaffre, E. (2012). The relationship between in-hospital mortality, readmission to the intensive care nursing unit and/or operating theater, and nurse staffing levels. Journal of Advanced Nursing, 68(5), 1073-1081. doi: 10.1111/j.1365-2648.2011.05812.x
A 4:1 nurse-patient ratio was associated with a 60% lower risk of death from AAA repair in high-volume hospitals.
Nicely, K., Sloan, D., & Aiken, L. (2013). Lower mortality for abdominal aortic aneurysm repair in high-volume hospitals is contingent upon nurse staffing. Health Services Research, 48 (3), 972-991. doi: 10.1111/1475-6773.12004