January 27, 2006

Raising number of R.N.s saves lives, money: study

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Peter Buerhaus, Ph.D., R.N.

Raising number of R.N.s saves lives, money: study

A study in the journal Health Affairs concludes that increasing the number of registered nurses and hours of nursing care per patient would save 6,700 lives and 4 million days of patient care in hospitals each year.

The research by UCLA's Jack Needleman, Ph.D., and Vanderbilt University School of Nursing's Peter Buerhaus, Ph.D., R.N., also finds that for hospitals that use both R.N.s and licensed practical nurses (L.P.N.s), greater use of R.N.s appears to pay for itself in fewer patient deaths, reduced lengths of hospital stay, and decreased rates of hospital-linked complications such as urinary tract infection, shock and/or cardiac arrest and upper gastrointestinal bleeding.

“We're entering the ninth consecutive year of a national nursing shortage,” said co-author Buerhaus, professor and senior associate dean for research at VUSN. “We hope this study stimulates a fresh debate on the contributions of nurses in improving the quality of hospital care.”

In 2002, U.S. hospitals employed 942,000 full time R.N.s and 120,000 full-time L.P.N.s. The study simulated the effect of several options that would increase nurse staffing to a “feasible” level for most hospitals. Key findings include:

• Greater use of R.N.s translates into fewer patient deaths, reduced hospital stays and decreased rate of hospital-linked complications.

• Increasing the number of hours of nursing care provided by both R.N.s and L.P.N.s would result in fewer deaths, avoidable complications and days of care.

• Expanding both the proportion of R.N.s and number of hours provided by L.P.N.s to reach the top quarter of hospitals (a combination of the other two options) saves the most lives and greatest number of patient days.

The authors conclude that increasing the proportion of R.N.s would require hospitals below the 75th benchmark to replace more than 37,000 L.P.N.s with R.N.s, at a cost of $811 million. However, this option also held the most benefits to hospitals and patients alike.

“From a hospital's perspective, increasing nurse staffing is costly. Nevertheless, greater use of R.N.s in preference to L.P.N.s appears to pay for itself,” said Buerhaus.

The cost of changing the mix without changing licensed hours is low relative to other options, and the authors estimate such a move would save $242 million over the short-term and $1.8 billion over time. Increasing nurses in hospitals with licensed hours below that in the top quarter of hospitals would require 114,456 more R.N.s and more than 13,000 L.P.N.s at a cost of $7.5 billion, and would end up saving $5.8 billion.

Increasing hours and raising the proportion of nurses who are R.N.s would require 158,000 more R.N.s, cost $8.5 billion and result in a $5.7 billion savings according to the study.

“These costs are not that high, and for the benefits obtained warrant serious consideration by policy makers, quality assurance agencies and others concerned with the quality of care,” Buerhaus added.

The study was supported by a grant from the Commonwealth Fund, a New York-based health foundation that focuses on improving quality and access to care.