Minimum nurse-to-patient ratios saves lives and lowers costs

Health system benefits from minimum nurse-to-patient ratios

Minimum nurse-to-patient staffing ratios in Queensland hospitals has saved lives, prevented readmissions, shortened hospital stays and reduced costs, according to a new study. 

Published in The Lancet, the study by QUT School of Nursing and the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing, evaluated legislation enacted in 2016 as a safety measure. 

QUT Faculty of Health Executive Dean Distinguished Professor Patsy Yates said prior to introducing the legislation, there were no mandated ratios.  

“The ratios were implemented because of emerging evidence about the importance of safe staffing levels in acute care hospitals,” Professor Yates said. 

“The Queensland legislation mandates 1:4 during the day and 1:7 at night in medical/surgical wards in acute care setting. Prior to introducing the legislation, we found that ratios varied considerably.”  

According to Professor Yates the publication illustrated the value of research that had real-world impact. 

“This research is a clear example of good public health policy in Queensland being derived from evidence-based research,” Professor Yates, who is co-director of QUT Centre for Healthcare Transformation, said. 

“The result benefits the health system, nurses, patients and the public at large.” 

The new policy limited the average number of patients per nurse to four, similar to pending legislation in New York and Illinois. 

The researchers collected extensive data before and after the legislation from about 17,000 nurses and analysed outcomes for more than 400,000 patients. 

In addition to finding a clear need for a safe hospital nurse staffing standard, they found the policy led to better nurse staffing in the intervention hospitals, while the staffing improvements stimulated by the policy led to better outcomes for patients.  

The researchers estimated that intervention hospitals had 145 fewer deaths, 255 fewer readmissions, and 29,222 fewer hospital days than if they had not implemented the policy. 

The policy also yielded a good return on investment for the public, with the savings due to fewer readmissions and shorter lengths of stay in hospitals about A$70 million, more than twice the cost of the additional nurse staffing. 

The research adds to the growing body of evidence that nurse staffing levels have a direct impact on patient safety.  

“We hope that other jurisdictions will use these findings to review their nurse staffing policies and ensure that they meet minimum requirements,” Professor Yates said. “We also hope that these findings will lead to further research to understand minimum nurse staffing levels in other areas such as aged care.”  

In addition, Professor Yates said the data demonstrated that nurses also benefited from the implementation of minimum nurse patient ratios. 

“We believe these benefits will result in reduced turnover and intention to leave the profession, and better wellbeing for nursing staff.” 

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals was published in The Lancet. 


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