Agency for Healthcare Research and Quality • www.ahrq.gov
Issue #14 March 2004
Hospital Nurse Staffing and Quality of Care
Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (AHRQ) and others. Yet increasing staffing levels is not an easy task. Major factors contributing to lower staffing levels include the needs of today’s higher acuity patients for more care and a nationwide gap between the number of available positions and the number of registered nurses (RNs) qualified and willing to fill them. This is evident from an average vacancy rate of 13 percent. This report summarizes the findings of AHRQ-funded and other research on the relationship of nurse staffing levels to adverse patient outcomes. This valuable information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment while optimizing quality of care and improving nurse satisfaction. continue over the next two decades. A Federal Government study predicts that hospital nursing vacancies will reach 800,000, or 29 percent, by 2020.2 The number of nurses is expected to grow by only 6 percent by 2020, while demand for nursing care is expected to grow by 40 percent. The most recent research shows a jump of 100,000 RNs, or 9 percent, in the hospital RN workforce between 2001 and 2002 because of increased demand, higher pay, and a weakening economy. However, since almost all of the
Making a Difference
Lower levels of hospital nurse staffing are associated with more adverse outcomes…Page 3 Patients have higher acuity, yet the skill levels of the nursing staff have declined…Page 5 Higher acuity patients and added responsibilities increase nurse workload…Page 5 Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000…Page 6 Hiring more RNs does not decrease profits… Page 6 Higher levels of nurse staffing could have positive impact on both quality of care and nurse satisfaction…Page 7
Periods of high vacancy rates for RNs in hospitals have come and gone, but the current shortage is different. According to a 2002 report by the workforce commission of the American Hospital Association, the nursing shortage “reflects fundamental changes in population demographics, career expectations, work attitudes and worker dissatisfaction.”1 In fact, the present situation may well
Author: Mark W. Stanton, M.A. Managing Editor: Margaret Rutherford Design and Production: Frances Eisel Suggested citation: Stanton MW, Rutherford MK. Hospital nurse staffing and quality of care. Rockville (MD): Agency for Healthcare Research and Quality; 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029.
increase came from RNs over age 50 who returned to the workforce and a greater influx of foreign-born RNs, this does not alter the structural features in the long term: the aging of the nurse population and the increasing unwillingness of young women to consider nursing as a profession.3 Today’s difficulties are further complicated by other changes in hospital care, such as new medical technologies and a declining average length of stay, that have led to increases in the amount of care required by patients while they are in the hospital. New medical technologies allow many less seriously ill patients who previously would have received inpatient surgical care to receive care in outpatient settings. Also, patients who in the past would have continued the early stages of their recovery in the hospital, today are discharged to skilled nursing facilities or to home. During the period 1980-2000, the average length of an inpatient hospital stay fell from 7.5 days to 4.9 days.4 An important consequence of these changes is that hospitals have a higher overall...