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Cited by 107Nursing education and managementHospital Admissions and OutcomesHealthcare Quality and Management

Patient Outcomes and Cost Savings Associated With Hospital Safe Nurse Staffing Legislation: An Observational Study

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Lasater, Karen B, Aiken, Linda H, Sloane, Douglas, French, Rachel, Martin, Brendan, Alexander, Maryann, McHugh, Matthew D·2021·BMJ Open
DOI 10.1136/bmjopen-2021-052899PMC PMC8655582
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Abstract

OBJECTIVE: To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals. DESIGN: : 87 acute care hospitals in Illinois. PARTICIPANTS: 210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical-surgical unit in a study hospital. MAIN OUTCOME MEASURES: Primary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios. RESULTS: Patient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse's workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse's workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million. CONCLUSIONS: Patient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical-surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.

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  • Nurses constitute an around-the-clock surveillance system in hospitals, closely monitoring changes in patients' clinical conditions and administering treatments and care as appropriate.

    “Nurses constitute an around‐the‐clock surveillance system in hospitals, closely monitoring changes in patients’ clinical conditions and administering treatments and care as appropriate [22].”

    From Longitudinal Analysis and Predictive Modeling of Nursing‐Sensitive Quality Indicators in Hemodialysis (2026) · cites this paper as [22]

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Cited by

Sorted by citations

Authors
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D.
Affiliations
  • Leonard Davis Institute of Health Economics (US)
  • University of Pennsylvania (US)
  • National Council of State Boards of Nursing (US)
Corresponding author
Lasater, Karen B
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2021-12
Volume
11
Issue
12
Pages
e052899
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2021-052899
PMC
PMC8655582
OpenAlex
W4200171498
Cited by
107
References
2
Citations by year
2026: 24 · 2025: 31 · 2024: 32 · 2023: 15 · 2022: 5
FWCI
14.39
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • National Council of State Boards of Nursing (N/A)
  • National Institute of Nursing Research, National Institutes of Health (R01NR014855, T32NR007104)
Topics
  • Health Sciences › Nursing › Research and Theory › Nursing education and management
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
nurse staffing ratios, nurse-to-patient ratio, nursing workload, 30-day mortality, length of hospital stay, hospital cost savings, nursing legislation, medical-surgical units, acute care hospitals, Illinois
MeSH terms
Workforce, Aged, Cross-Sectional Studies, Medicare, Hospitals, Humans, Nursing Staff, Hospital, Personnel Staffing and Scheduling, Quality of Health Care, United States, Cost Savings

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