The Case for Nurses

Pioneering work done by Linda H. Aiken at the University of Pennsylvania in 2002 showed that each extra patient a nurse had above an established nurse-patient ratio made it 7 percent more likely that one of the patients would die. She found that 20,000 people died a year because they were in hospitals with overworked nurses.

Research also shows that when floors are adequately staffed with bedside nurses, the number of patients injured by falls declines. Staff increases lead to decreases in hospital-acquired infections, which kill 100,000 patients every year. (NYT)

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  1. Donald says:

    Pioneering work done by Linda H. Aiken at the University of Pennsylvania in 2002 showed that each extra patient a nurse had above an established nurse-patient ratio made it 7 percent more likely that one of the patients would die. She found that 20,000 people died a year because they were in hospitals with overworked nurses.

    Wow, that is horrifying.

  2. Buster says:

    Go figure, the more patients a nurse has to look after, the more likely a problem patient will fall through the cracks. This doesn’t sound like rocket science to me.

    • Levin says:

      It isn’t, but the fact that they have calculated risk of death (aka mortality) rates based on overworked nurses is pretty cool, not that people are dying, but that they can figure that out.

  3. JD says:

    Obviously, having more medical personnel will improve health outcomes, but will they improve it more than cost? If we spend $50,000 on a nurse that ends up preventing $20,000 worth of additional medical expenses, it isn’t worth it.

    • Jason says:

      These are lives not dollar signs DEWAINE.

    • Brandon says:

      Which is more valuable Dewaine, Life or Money?

    • JD says:

      ? Every decision in life is based on a cost/benefit analysis. Neither of you would say that we should give up every human achievement, advancement and comfort to save one life, correct? Therefore you are saying the costs outweigh the benefits OR life is not worth as much as the money.

      • Taylor says:

        JD you are basing your “life” theory on a biased social experiment. Just because you study economics doesn’t mean human nature is dictated by your economic principles.

        • JD says:

          If it isn’t, then we are studying the wrong things. Although, I am open to that possibility…

        • JD says:

          But, that is a good reason why everyone should be in control of their own lives. I prefer that I don’t have to make decisions that alter somebody else’s life.

    • Dewaine says:

      What did I do?

    • Dewaine says:

      But, yes, I agree with JD. How did you guys know?

    • Richard says:

      Aren’t you forgetting a benefit of saving a patient’s life?

      It’s not just the $20,000 in medical expenses prevented; it’s the productivity stream of that person.

      So yes, a $50,000 nurse that ends up preventing $20,000 of additional medical expenses is likely worth it, if that person earns $30,000 (in NPV terms) over the rest of their lives.

      • Richard says:

        The above is for if a person dies without the additional medical expenses.

        But it can also hold (though it is less binding) if the person does not die. There is the intrinsic value each person puts on “good health”, as well as the fact that being in ill health does decrease productivity and income.

      • JD says:

        I agree with everything that you are saying. My example was oversimplified, but the principle remains the same.

        • Richard says:

          I don’t disagree that cost-benefit analysis is highly useful, as you stated.

          I just tend to think that we will probably err on the side of not hiring because a lot of the benefits (but not necessarily the costs) aren’t easily quantified (quality of life, though there have been attempts; value of a sicker-than-normal day).

          And that we may be producing a situation where, based on the CBA, we do have too few nurses. Though we already have far too few in too many departments around the country. Especially ED’s.

          • JD says:

            Again, I agree with everything that you’re saying. A cost/benefit analysis has to try and take all of this into account and, in cases like this, we should probably try to err on the side of too much funding.

  4. Dewaine says:

    Another important side to this is that spending too much money means somebody else has too little. Yeah, we would be able save lives by spending all of the money in the world on healthcare, but that means we will be lacking funding in clean food and water, safe living conditions, etc. Point being that saving lives in health care might cost them elsewhere IF we aren’t spending the appropriate amount.

    • Perry says:

      Well, that’s a good point Dewaine, because the things you mentioned, such as clean food and water have a direct impact on health. Preventing illness can certainly have a huge effect on money spent on care for illnesses. Certainly, there has to be a balance.

  5. Linda Gorman says:

    The data are averages based on self-report by nurses. The authors caution that Pennsylvania and New Jersey are a convenience sample. The data on mortality are secondary data from state agencies that were assigned to the average working environment the nurses reported. The survey was restricted to RNs although staffing ratios might differ if LPNs and certified nurse assistants were included.

    The differences in the logistic regression coefficients are fairly small and the confidence intervals for the different states overlap. Given the possibility of rent seeking, it would be nice to see more work on this with better data.

  6. Hoads says:

    The majority of advances in healthcare is concentrated in mrdical technology and the majority of growth in healthcare is in management and administration. Investments in the actual delivery of medical care at the bedside is sorely lacking and the blame can be placed squarely on the nursing profession. Other than the institution of electronic medical records and high tech equipment and patient monitoring, the practice of hospital nursing has been at a virtual stand still for decades.

    The nursing profession suffers from a lack of creativity and entrepreneurship in addressing its antiquated modes of providing bedside care and would greatly benefit from an injection of transformative change agents within their ranks that could reengineer nursing care in a way that adds value, efficiencies and patient advocacy to its mission interacting within a rapidly changing healthcare system.

    • Perry says:

      Well, the same could be said for the medical profession in general. With all the innane and redundant paperwork,and waste from ridiculous regulations it’s now wonder there’s so little time to invest in innovation in the medical field.

  7. Jw says:

    Hoards, nurses are making leaps and bounds in changing how we provide care by using evidence-based practice. In other words, we nurses are using care proven by research to provide the best care possible. In regards to the article, any floor nurse could have told you that more nurse with less patients to care for can save lives. That is why nursing associations are lobbying for mandatory lower nurse to patient ratios.