If you or a loved one were ever hospitalized, you know how important nurses were in providing care. You probably saw the nurse (if there were enough of them) more than anyone else while hospitalized. The nursing care you received helped prevent complications, coordinate the services you needed after discharge from the hospital, and maybe even reduced the number of days you had to spend in the hospital. Despite the positive effects the right number and kind of nurses can have on your hospitalization, nurses are often the first targets of cost cutting measures by healthcare organizations. For years, researchers have tried to assign a dollar amount to the effect of quality nursing care to hospital patients.
They finally have, with staggering results.
The American Nurses Association (ANA) released a press release this week highlighting the results of an independent study conducted by the Lewin Group. Dall et al (2009) published the complete article in the highly respected health services research journal Medical Care. The article is available free to the public (See Dall et al (2009), The Economic Value of Professional Nursing, 47(January): 97-104 at http://lww-medicalcare.com).
The study "culled findings from 28 different studies that analyzed the relationship between" the following factors (explanations in parentheses):
Higher Registered Nurse* staffing (how many patients nurses have to care for on their shift)
AND
Patient outcomes:
- Reduced hospital-based mortality (the death rate during hospitalization)
- Hospital-acquired pneumonia (the rate at which people develop pneumonia when in the hospital)
- Unplanned extubation (when a confused patient on a ventilator in an intensive care unit setting pulls out their breathing tube)
- Failure to rescue (when a patient dies unexpectedly and the healthcare team cannot save them)
- Nosocomial bloodstream infections (a blood infection developed while hospitalized)
- Length of stay (how long you stay in the hospital).
*A registered nurse (RN) has either a 3 year associate's degree or a bachelor's degree in nursing.
"The findings demonstrate that as nursing staffing levels increase, patient risk of complications and hospital length of stay decrease, resulting in medical costs savings, improved national productivity and lives saved." (ANA Press Release, 2009)
How much money is saved by preventing these complications?
According to the press release & article:
"Estimates from this study suggest that adding 133,000 RNs to the acute care hospital workforce would save 5900 lives per year.
The productivity value of total deaths averted is equivalent to more than $1.3 billion per year, or about $9900 per additional RN per year."
The additional nurse staffing would decrease hospital days by 3.6 million. More rapid recovery translates into increased national productivity, conservatively estimated at $231 million per year.
"Medical savings is estimated at $6.1 billion, or $46,000 per additional RN per year.
Combining medical savings with increased productivity, the partial estimates of economic value averages $57,700 for each of the additional 133,000 RNs.
If you don't know, the average salary for a new RN is $45,000 per year in the US. With those numbers, that means that the cost of adding the new nurses to the healthcare system pays for itself. It even pays for experienced nurses.
Also, imagine the economic impact of 133,000 people earning an average of $45,000 per year on the current economy? If you guessed around $5 billion in gross earnings, you're on the right track.
Without these kinds of cost savings, YOU, the consumer --whether you have health insurance or not-- end up picking up the costs through higher insurance premiums or out-of-pocket expenses.
Sounds great, but what are the obstacles?
Many hospitals only see nurses as expenses in their budget. They usually cut nursing staff first when budgets get tight. So, in this economic downturn, hospitals may cut nursing staff to save money, but inadvertently cost our health care system more money because they cut staff. This research shows the consequences of those kinds of policies.
Another problem is that there simply aren't enough teachers for nurses. Nursing schools in the United States turn away 30,000 applicants per year simply because there are too few faculty. Why so few? Faculty pay for nurses tends to be low if they do not have a PhD, the minimum requirement for better paying faculty jobs in colleges and universities. Only 1% of the US's 2.9 million nurses have a PhD and not all of them teach in nursing schools. Universities and colleges also pay teachers based on their education level, so masters prepared nurses with the most recent experience do not get paid well when working in universities. That deters many of them from teaching positions. There's also a screwy piece of economics where in some places, experienced hospital staff nurses make more money than nursing faculty.
What can you do as a policy advocate and a consumer? (There's research to back up all these statements)
Expect your local hospital to staff their organization appropriately and provide nurses with the support they need to take care of YOU and your loved ones. For staffing, most general patient care units, that means not more than five patients per nurse during the day shift and not more than eight at night. Other units, like intensive care and obstetrics, have different standards. For support, that means staff education, good supply management, and positive working relationships (to name a few).
Lobby your state legislature and national representatives for mandatory RN staffing ratios and incentives that encourage people to take teaching positions to educate more nurses.
Author note:
This is a complex topic. If you have specific questions, please feel free to contact me via Kos mail. Furthermore, I am a member of the ANA but not involved in the leadership activities of the organization. I also did not have any involvement in this study.