Reduced RN staffing increases stay length, readmission and death risk: Study

Supplementing gaps in nursing staff with lower-wage personnel like licensed practical nurses or aides can increase patient risks of readmission, death, longer stays and lower satisfaction, according to a study published June 10 in Medical Care.

The study, led by researchers at Philadelphia-based University of Pennsylvania School of Nursing, found that the outcomes of 6.5 million Medicare patients at 2,676 general acute care hospitals across the U.S. are worse even with modest substitutions for RN care. 

A 10% reduction in RN staff raises the risk of patient deaths by 7%, according to the study. Readmission rates associated with a 10% reduction in RN staff were also found to make up about $68.5 million in avoidable costs paid by Medicare.

"The public has no way of assessing the adequacy of hospital RN staffing, and in all but two states (California and Oregon) there are no regulations establishing minimum safe RN staffing requirements in hospitals to protect the safety of patients"  Linda Aiken, PhD, RN, senior study author and professor of nursing and founding director of [the Center for Health Outcomes and Policy Research at the University of Pennsylvania, said in a news release. "Rather than replacing RNs with less-qualified staff, hospital leaders should focus on improving their work environments to retain RNs."

Even if the same total number of staffing hours is kept the same after reducing nursing staff, if RN care is replaced, both human and economic consequences could be "substantial", the authors wrote.

"Reducing the proportion of RNs in hospitals, even when total nursing personnel hours are kept the same, is likely to result in significant avoidable patient deaths, readmissions, longer lengths of stay, and decreased patient satisfaction, in addition to excess Medicare costs and forgone cost savings to hospitals," the authors concluded.

The findings come as many hospitals have embraced "team-based" nursing models, which involve bringing LPNs back to the bedside and aim to ensure RNs are able to work at the top of their license.

Systems that have recently seen success with these models — such as Altamonte Springs, Fla.-based AdventHealth — have taken a comprehensive approach that considers patient acuity, work intensity and nurse experience when making staffing assignments.

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