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New York State’s Hospital Nurse Staffing Legislation Predicted to Save Lives and Money

According to a new study published in Medical Care, improving hospital nurse staffing as proposed in pending legislation in New York state would likely save lives. The cost of improving nurse staffing would be offset by savings achieved by reducing hospital readmissions and length of hospital stays.

Researchers at the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing, conducted independent research in early 2020 on whether pending nurse staffing legislation in New York state is in the public’s interest. The study of 116 hospitals and 418,000 Medicare patients documented large differences in patient-to-nurse ratios by hospital from an average of 4.3 patients for each nurse to as many as 10.5 patients per nurse. The wide variation in patient-to-nurse ratios across hospitals in New York is contributing to avoidable deaths and unnecessary costs.

The new study finds hospital deaths and costs of care are significantly lower in hospitals with better nurse staffing. Each additional patient added to a nurse’s workload is associated with 13% higher in-hospital mortality and 8% higher readmissions. Similarly, the odds of staying a day longer in the hospital, a major cost factor, increased by 9% for surgical patients and 5% for medical patients.

Lead author Karen Lasater, PhD, RN, an assistant professor and CHOPR researcher said, “Results show that improving nurse staffing in New York hospitals could substantially reduce deaths and save money that could go to funding improved staffing.”

Researchers estimated that if all New York hospitals had staffed at levels recommended in pending state legislation of not more than 4 patients per nurse on medical and surgical units, over a two-year period more than 4,370 deaths could have been avoided and over $720 million saved just among Medicare patients alone and likely considerably more across all hospitalized patients.

Co-author, Linda H Aiken, PhD, RN, a senior researcher at CHOPR and professor at the University of Pennsylvania said, “This independent scientific study shows that setting a quality standard for nurse staffing in hospitals is in the public’s interest. It is also feasible to fund because of significant savings associated with avoided days of care associated with better patient care.”

In associated research, CHOPR funded a Harris Poll in 2020 showing that 91% of the public surveyed in a national sample agreed that hospitals should be required to meet safe nurse staffing standards.

The Safe Staffing for Quality Care Act (A2954/S51032) currently pending action in the NY Legislature sets a minimum nurse staffing requirement for all New York state hospitals that would serve to bring hospitals with poor staffing to an evidence-based minimum standard.

Evidence suggests that New York state has a sufficient nurse supply to meet the ratios proposed in the legislation. California which successfully implemented similar legislation 17 years ago has substantially fewer nurses (11.3 nurses per 1000 population) than New York state (18.7 per 1000 population). The Nurse Licensure Compact providing multi-state licensure for nurses has been passed in 34 states but not in New York where the Governor had to use temporary emergency powers during the Covid-19 emergency to allow NY hospitals to recruit nurses.

Other recent publications from this same study by the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing showing that mandating minimum nurse staffing standards in the New York state are in the public’s interest:

Lasater KB, Sloane DM, McHugh MD, Cimiotti JP, Riman KA, Martin B, Alexander M, Aiken LH. Evaluation of hospital nurse-to-patient ratios and sepsis bundles on patient outcomes. American Journal of Infection Control. 2020. https://doi.org/10.1016/ajic.2020.12.002 Open Access.

Lasater KB, Aiken LH, Sloane DM, French R, Martin B, Reneau K, Alexander M, McHugh MD. 2020. Chronic hospital nurse understaffing meets COVID-19. BMJ Quality & Safety. Epub ahead of print 18 August 2020. doi:10:1136/bmjqs-2020-011512. Open Access.

The study was carried out by the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing in partnership with the National Council of State Boards of Nursing. Funding for the study was from the National Council of State Boards of Nursing, the National Institute of Nursing Research/NIH, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania.