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Penn Nursing > Media > California Nurse Staffing Study > Nurse Staffing and Patient Mortality

Nurse Staffing and Patient Mortality

Registered nurses provide an around the clock surveillance system in every hospital for early detection and prompt intervention when patients' conditions worsen. The effectiveness of this system is influenced by the number of RNs available and the number of patients they oversee.

University of Pennsylvania researchers have determined that patients who have common surgeries in hospitals with poor nurse staffing ratios have an up to 31 percent increased chance of dying. The study examined data collected from 168 hospitals, 232,342 surgical patients and 10,184 nurses in Pennsylvania. Data from relatively common surgeries (gall bladder), orthopedic surgeries (knee or hip replacement), and vascular surgeries, excluding cardiac surgery such as bypass were examined.

The researchers found that every additional patient in an average hospital nurse's workload increased the risk of death in surgical patients by seven percent - and those patients with life-threatening complications were also less likely to be saved where nurses' patient loads were heavier.

 For every 100 surgical patients who die in hospitals with 4:1 patient ratios, the number that would die in hospitals with higher ratios would be:


Specifically, researchers found that if hospitals staffed at eight patients per nurse rather than four, the risk of hospital deaths would increase by 31 percent. This translates to as many as 200,000 avoidable deaths in the United States.

Educational Levels of Hospital Nurses and Patient Mortality

Registered nurses in the United States receive basic education in one of three types of programs: a three year diploma program in hospitals, associate degree nursing programs from community colleges, and baccalaureate nursing programs from college and universities.

The Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing conducted a study of 232,342 patients and found that raising the percentages of bedside registered nurses with a BSN from 20 to 60 percent would save four lives for every 1,000 patients.

Patient deaths after surgery are highest in hospitals where nurses with lower levels of education care for more patients --> TABLE

Patients have the highest risk of death in hospitals where nurses with less education care for more patients. When 20 percent of the nursing staff has a BSN and care for eight patients there are 24 deaths per 1,000 patients. That number decreases to 16 deaths when 60 percent of a hospital nurse staff has their BSN.

Patient deaths after surgery are highest in hospitals where nurses with lower levels of education care for more patients --> TABLE

43 percent of hospitals in the United States have nurses with at least a bachelor's degree. But a 10 percent increase in the proportion of hospital staff nurses holding a BSN would be associated with a five percent decrease in patient mortality.

The Institute of Medicine's Future of Nursing Report makes a number of suggestions for the nursing and healthcare fields:

  • At least 80 percent of nurses should have bachelor's degrees by 2020 and at least 10 percent should go on to get a doctorate
  • "Scope of practice" barriers should be removed to allow nurses to perform many services previously reserved by doctors
  • Nurse-residency programs should be implemented
  • The number of states where nurses can practice independently should be increased, in 2010 14 states plus the District of Columbia allowed nurse practices
  • Medicare should expand its authorization of advance practice nurses to perform admission assessment as well as certification of patients for home healthcare services and for admission to hospice and skilled nursing facilities