Insufficient Nursing Staff Associated with Prolonged Hospital Stays and Increased Mortality Rates

A recent comprehensive study published in BMJ Quality & Safety has revealed that inadequate staffing of permanent nurses in hospital wards correlates with extended patient hospitalizations, higher rates of readmission, and increased mortality risk. The research indicates that addressing nursing shortages is not only crucial for patient outcomes but also economically beneficial, estimating a savings of approximately £4,728 for each additional year of healthy life gained per patient.

The study highlights that both unintentional understaffing due to unfilled positions and intentional reductions in nursing staff for cost-saving purposes can endanger patient safety. Researchers pointed out that these staffing issues significantly contribute to ongoing challenges in nursing recruitment and retention.

To assess the impact of nursing staff levels on patient outcomes, the study analyzed data from four NHS hospital trusts in England, covering a diverse range of staffing configurations and serving varied populations. The data, obtained from electronic health records and staffing rosters, encompassed over 626,000 patients across 185 acute care wards between April 2015 and March 2020.

Focusing on two main roles--registered nurses (RNs) and nursing support staff (such as healthcare assistants)--the research aimed to establish the relationships between staffing levels and key patient outcomes, including mortality, readmission rates, and length of hospital stay. It was found that patients in wards with insufficient RN staffing experienced a 5% higher mortality rate compared to those in adequately staffed wards, alongside a 15% readmission rate compared to 14% in better-staffed environments.

Patients typically spent an average of eight days in the hospital, receiving less than five hours of care from RNs and just under three hours from nursing support staff during the initial five days of their stay. Those experiencing understaffing received an average of one hour and nine minutes less care per day during this period.

The findings also indicated that for every day a patient was under the care of understaffed nursing teams, the risk of death increased by 8%, while the risk of readmission rose by 1%. Moreover, prolonged understaffing contributed to a significant 69% increase in length of stay when sustained for five consecutive days.

During the study, a total of 31,885 patient deaths were recorded. The estimated total expenditure for the care provided to the patients included in the study was around £2.6 billion, averaging £4,173 per admission. The analysis demonstrated that rectifying staffing shortages for both RNs and nursing support staff would incur an additional cost of £197 per patient admission, which could prevent over 6,500 deaths and yield approximately 44,500 years of healthy life gained.

While current staffing practices have shown to be less effective and more costly when relying on temporary agency staff, the study emphasizes that investing in permanent nursing positions yields better outcomes for both patients and healthcare systems. The researchers argue that focusing solely on acute patients may not be the most effective strategy, suggesting that improving general ward staffing levels could also enhance care for patients with more complex needs.

Despite the observational nature of this study, which limits the ability to establish definitive cause-and-effect relationships, the findings underscore the critical need for healthcare policymakers to prioritize adequate nursing staff levels in hospitals. This approach could lead to improved health outcomes and significant cost savings for healthcare systems.