Nurse Staffing Levels in Hospitals Affect Mortality

Hospital administrators are under a lot of pressure, these days.  Financial considerations coupled with the shortage of nurses means that available staff is forced to seek further efficiency in their caring for patients.  Not surprisingly, something has to give, and it looks like it’s the standards of patient care. This is revealed in an analysis conducted by UCLA researchers and published in the New England Journal of Medicine.

Data came from a large academic hospital from 2003 to 2006; they represented 43 hospital units, almost 200,000 patients, and 175,000 8-hour nursing shifts.  The target number of RN-hours for each shift were determined for each unit, and compared with the actual RN-hours available. Shifts were flagged when actual staffing was 8 hours or more below the target level.  (Adjustments were made for the time patients were away from the unit for procedures.)     

RN staffing was within 8 hours of the target level for all but 16% of shifts; deficiencies were more often seen in critical care units, rather than general care units – 19.4% vs. 14%.  Importantly, there was a 2% increase in the risk of mortality for each below-target shift a patient was exposed to.

For another assessment, patient turnover was the focus.  A measure that accounted of each shift’s admissions, transfers, and discharges was elaborated, and results compared with the mortality rate.  A shift was defined as having a high turnover if the rate was greater than a given value based on previous analysis.  As expected, there was a significant association between increased mortality and high patient turnover –an increase of 4% in the risk of mortality for each high-turnover shift. 

There are some caveats in interpreting these results: the study didn’t have information on different care-delivery models used, the numbers of non-RN staffing targets and whether these targets were met, and differences in physical layout of hospital units.  However, the findings strongly suggest that staffing of RNs below target levels is linked to higher patient mortality –something we all need to pay attention to in this era of health management financing and restructuring.