Nurse Patient Ratios | Talking Points for Safe Nurse Staffing

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:
1. Hospital mortality;
2. Failure to rescue;
3. Cardiac arrest;
4. Hospital-acquired pneumonia
5. Respiratory failure;
6. Patient falls (with and without injury); and
7. 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.

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