Substituting Lower-Wage Staff for Registered Nurses Tied to Worse Outcomes

Harms include avoidable patient deaths, readmissions, longer lengths of stay, excess Medicare costs and forgone cost savings
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Medically Reviewed By:
Meeta Shah, M.D.

TUESDAY, June 25, 2024 (HealthDay News) -- Reducing the proportion of registered nurses (RNs) in hospitals, even when total nursing personnel hours are kept the same, results in worse outcomes, decreased patient satisfaction, and higher costs, according to a study published in the July issue of Medical Care.

Karen B. Lasater, Ph.D., R.N., from the University of Pennsylvania School of Nursing in Philadelphia, and colleagues evaluated whether reducing the proportion of RNs to total nursing staff in hospitals is in the best interest of patients, hospitals, and payers. Analysis included 6.6 million Medicare patients treated at 2,676 general acute-care U.S. hospitals in 2019.

The researchers found that a 10 percentage-point reduction in RNs was associated with 7 percent higher odds of in-hospital death, 1 percent higher odds of readmission, and 2 percent increase in expected days, as well as lower patient satisfaction. It is projected that a 10 percentage-point reduction in RNs would result in 10,947 avoidable deaths annually and 5,207 avoidable readmissions, translating to roughly $68.5 million in additional Medicare costs. Additionally, hospitals would forgo nearly $3 billion in cost savings annually from reducing the proportion of RNs because of patients requiring longer stays.

"Estimates represent only a 10 percentage-point dilution in skill mix; however, the team nursing model includes much larger reductions of 40 to 50 percentage-points -- the human and economic consequences of which could be substantial," the authors write.

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