Agency for Healthcare Research and Quality has recently issued a new synthesis of research studies funded by AHRQ and others that indicates that hospitals with lower nurse staffing levels, nurses who spent less time with patients, or fewer registered nurses tend to have higher rates of poor patient outcomes - including pneumonia, shock, cardiac arrest, and urinary tract infections. Three of the studies, in fact, found that pneumonia rates are particularly sensitive to nurse staffing levels, which were measured as the ratio of nurses to patients or as nursing hours per patient per day.

Several studies indicated that nurse-staffing levels might also be associated with mortality rates. Two studies showed that the 30-day mortality rate and the likelihood of failure-to-rescue are higher when nurse-staffing levels are lower. Another study showed that a higher proportion of more highly educated nurses could reduce the 30-day mortality rate and the odds of failure-to-rescue.

Another important finding was that increasing nurse-staffing levels does not significantly decrease a hospital’s profits, in contrast to increases in non-nurse staffing.

Further studies that support these findings were led by Sung-Hyun Cho, Ph.D., M.P.H., R.N., of the Korea Institute for Health and Social Affairs, Seoul and formerly of the University of Michigan at Ann Arbor. Dr Cho and his colleagues examined the impact of nurse-staffing levels on adverse events that, according to an expert panel, could be minimized or prevented by adequate nurse-staffing: fall/injury, pressure ulcer, problematic drug reaction, pneumonia, wound infection and sepsis.

Most surgery patients (93 percent) did not suffer from any adverse events. However, when adverse events did occur, pneumonia occurred most frequently (nearly 3 percent of adverse events). An increase of one hour worked by RN’s per patient day was associated with an 8.9 percent decrease in the odds of pneumonia. Similarly, a 10 percent increase in the proportion of RN’s to overall nursing staff was associated with a 9.5 percent decrease in the odds of pneumonia. Overall, the occurrence of pneumonia was associated with an increase of 5.1 to 5.4 days in hospital length of stay, an increase of 4.67 to 5.55 percent in the probability of death, and a jump of $22,390 to $28,505 in costs.

Over the past decade, many U.S. hospitals reduced the number of RN’s and substituted licensed practical nurses (LPN’s) for RN’s to reduce cost. In response to these alleged cost-containment measures, there has been a call for government regulation of minimum staffing levels to protect the quality of care received by hospitalized patients.

A new study by the AHRQ found that higher RN staffing levels were associated with fewer deaths among elderly Medicare patients hospitalized for first-time heart attack. The researchers suggest that more astute RN clinical assessments and early identification of heart attack complications by RN’s, such as congestive heart failure or pulmonary edema, may explain the survival advantage of patients treated at hospitals with higher RN staffing. These findings link the important effect of nurse-staffing upon in-hospital mortality.

Legislation such as The Nurse Staffing for Patient Safety and Quality Care Act of 2004 (Rep. Jan Schakowsky, D-IL) looks toward providing hospitals with guidelines to protect patients and staff from injuries associated with inadequate staffing; guidelines that most healthcare-related facilities have declined to institute voluntarily. Until, however, this type of legislative effort actually becomes law, only organized nurses unions will possess the power to contractually bargain for safe staffing standards for their patients, for their profession and for themselves.