Low Nurse Staffing Levels at Hospitals Increase Surgical Patients’ Risk of Dying, New Study Says

Patients recovering from routine surgery at hospitals with fewer nurses per patient have a greater risk of dying, according to a study published in today's issue of the Journal of the American Medical Association, the Los Angeles Times reports. For the study, researchers at the University of Pennsylvania examined the mortality rates of 232,342 patients who were cared for by 10,184 nurses at 168 Pennsylvania hospitals. The patients had general orthopedic or vascular surgeries in 1998 and 1999 and were monitored for 30 days following their procedures. The study found that patients' risk of death increased 7% for each additional patient under one nurse's care (Ornstein, Los Angeles Times, 10/23). Overall, patient-to-nurse ratios at the hospitals studied differed from 4-1 to 8-1; researchers estimated that a nationwide ratio of 8-1 compared to a ratio of 4-1 would result in a 31% increase in the mortality rate, or 20,000 additional deaths (Uhlman, Philadelphia Inquirer, 10/23).

The study also found nurses at the hospitals with the highest patient-to-nurse ratios are more than twice as likely to "experience job-related burnout" and nearly twice as likely to "be dissatisfied with their jobs" as nurses at hospitals with the lowest ratios. Such dissatisfaction was an accurate predictor of whether nurses intended to leave their jobs within one year, the study concluded (Aiken et al., JAMA, 10/23-10/30). The study, which was funded by NIH and the National Institute of Nursing Research, suggests that improving nurse staffing levels would reduce the number of hospital patient deaths and would also "keep nurses on the job" at a time when many facilities are experiencing severe nursing shortages, the AP/Houston Chronicle reports (Bellandi, AP/Houston Chronicle, 10/22). However, researchers did not recommend an "ideal or maximum" patient-to-nurse and instead said hospitals should implement "reasonable staffing" for their particular facility, the Inquirer reports (Philadelphia Inquirer, 10/23).

Linda Aiken, lead author of the study and director of the University of Pennsylvania's Center for Health Outcomes and Policy Research, said that the findings illustrate a "really strong and unequivocal relationship between nurse staffing and mortality" and that the results should "help resolve the issue of whether this is a big problem or a small problem" (Los Angeles Times, 10/23). Diana Mason, editor-in-chief of the American Journal of Nursing, said the study is "vital and long overdue," Long Island Newsday reports. She added, "The nursing shortage is a major public health problem. ... Nurses are the surveillance system of the hospital and without them, patients suffer" (Ricks, Long Island Newsday, 10/23). Nationwide, about 13% of all nursing jobs were unfilled last year, the Washington Post reports. By 2020, there could be a 400,000-nurse shortage, according to Department of Labor statistics.

To address some of the problems identified in the study, more than 20 states have enacted or have "seriously considered" legislation mandating patient-to-nurse ratios (Downey, Washington Post, 10/23). California is the first and only state thus far to approve patient-to-nurse ratios for specific hospital departments; the regulations take effect in January 2004 (Los Angeles Times, 10/23). According to the Contra Costa Times, the study "validat[es]" California's ratio law, which researchers note "represents a credible approach to reducing mortality and increasing nurse retention in hospital practice" (Silber, Contra Costa Times, 10/23). However, Roger Baumgarten, a spokesperson for the Hospital and Healthsystem Association of Pennsylvania, said, "Mandating ratios doesn't make nurses appear" and suggested instead that states should implement programs to make education "more available and attractive" to potential nurses, the Inquirer reports (Philadelphia Inquirer, 10/23). The study is available online. NPR's "All Things Considered" yesterday reported on the nurse staffing study (Knox, "All Things Considered," NPR, 10/22). The story is available online. In addition, NPR's "Morning Edition" today reported on the study ("Morning Edition," NPR, 10/23). The report will be available online after noon ET.