Safe Staffing: Evidence demonstrated daily

The American Nurses Association (ANA) believes that safe staffing levels can’t be achieved by legislated ratios. Instead, staffing levels should be based on data that link staffing and skill mix on a unit with patient outcomes and work environment characteristics. The best staffing level for a unit may differ by shift, day of week, or month or with changes in the work environment.
Other factors influencing the optimum staffing level include the nurses’ educational levels, their years of experience on the unit, and their experience with the patient population. Work environment considerations, such as autonomy and nurse-physician interactions, as well as years of nursing experience also should be factored into the equation. The final decision on nurse staffing should be made by the nursing team of the unit, using regularly collected data and relevant national comparisons.

Available evidence
Plenty of data showing the harmful effects of staffing shortfalls exist. Some 1,400 hospitals collect unit-level data and submit the information quarterly to the National Database of Nursing Quality Indicators. Over several years of studying trends, these hospitals have found that nursing hours per patient day, the number of nurses, the skill mix of the nursing staff, and the adverse outcomes experienced by patients create a metric for each unit that supports the right level of nurse staffing.
ANA has published two volumes of case studies from hospitals of every size and type that have experienced the right mix of staffing and outcomes to keep patients safe. Data show that based on a unit’s patient mix, staffing mix, and other factors, positive relationships exist between nursing and the number of falls, pressure ulcers, infections, and other adverse events. The staff mix that brings these adverse events towards zero becomes the desired nurse staffing for that unit. Also, numerous research studies have built a body of evidence to substantiate the value of RN staffing.
A large-scale study report, “The economic value of professional nursing,” in the January 2009 issue of Medical Care, describes the value of one additional RN full-time equivalent on adverse events suffered by patients. Commissioned by over 85 national nursing organizations, the report reviews findings from 28 studies analyzing the relationship between higher RN staffing and several patient outcomes: reduced hospital-based mortality, hospital-acquired pneumonia, unplanned extubation, failure to rescue, hospital-acquired bloodstream infections, and length of stay.

Financial benefit
The findings in this report demonstrate that as nurse staffing levels increase, the risk of complications and the length of hospital stays decrease, leading to savings in medical costs, improved national productivity, and saved lives. According to the authors, “Estimates from this study suggest that adding 133,000 RNs to the acute care workforce would save 5,900 lives per year. The productivity value of total deaths averted is equivalent to more than $1.3 billion per year, or about $9,900 per additional RN per year.”
The additional RN staffing would decrease patient hospital days by 3.6 million. More rapid recovery translates into increased national productivity, conservatively estimated at $231 million per year. “Medical savings are estimated at $6.1 billion, or $46,000 per additional RN per year. Combining medical savings with increased productivity, partial estimates of economic value average $57,700 for each of the additional 133,000 RNs.”
For references that substantiate the value of RN staffing and more information on ANA’s safe staffing efforts, go to www.safestaffingsaveslives.org.

Selected reference
Dall TM, Chen YJ, Seifert, RF Maddox TJ, Hogan TF. The economic value of professional nursing. Med Care. 2009;47(1):1-8.

Mary Jean Schumann is the chief programs officer of the American Nurses Association.

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