Nurse-to-Patient Ratios as a Cost-Effective Safety Intervention

Introduction

The issue of nurse-to-patient ratios within large clinical settings has been well documented. The data gathered from this significant problem has created avenues of research that delve into many different aspects of knowledge and understanding. The clinical problem discussed in Rothberg et al. (2005) is based on the idea that harmful patient-to-nurse ratios negatively affect a hospital's ability to heal patients effectively. Their research article sought to find relationships between nurse-to-patient ratio data and cost-effective safety interventions.

The authors established the significance of this study by premising their argument on the fact that new state laws are mandating certain patient-to-nurse ratios. The reader should be interested in this study because the simple act of under- or over-staffing a clinical setting may constitute a violation of the law. The authors wrote: "Some advocates propose that lower PTN ratios might actually save money by decreasing nurse turnover, hospital complications and length of stay. If this were shown to be true, hospitals might limit PTN ratios without legislation. To date, research on nurse staffing has not considered the cost effectiveness of different PTN ratios."

The authors of this study looked to improve upon known sources of empirical data by determining the cost-effectiveness of various nurse-to-patient staffing ratios. This was an economic and financial approach to the problem. While reducing patient mortality to an economic dollar figure is somewhat reductive, this type of investigation can be useful for finding adequate nurse-to-patient ratios guided by economic evidence.

Purpose and Research Questions

The authors hypothesized that by conducting a cost analysis of nurse staffing models and their relationship to patient outcomes, a better understanding could be reached — and hospitals could adopt staffing models that reduce the need for greater government involvement in healthcare and medical practices. The methods associated with this research question combined several different tools and sources of data. As the article reported: "This was a cost-effectiveness analysis from the institutional perspective comparing patient-to-nurse ratios ranging from 8:1 to 4:1. Cost estimates were drawn from the medical literature and the Bureau of Labor Statistics. Patient mortality and length of stay data for different ratios were based on 2 large hospital-level studies. Incremental cost-effectiveness was calculated for each ratio and sensitivity and Monte Carlo analyses performed."

In order to bolster the credibility of this investigation, the authors incorporated relevant literature and empirical data throughout the report. They referred to several studies that documented prior investigation into nurse-to-patient ratios and how those ratios may positively or negatively affect patient outcomes. The authors successfully wove this evidence throughout the article to support their conclusions. One notable example is the following passage:

Literature Review

"Can the same benefits be achieved through the use of licensed practical nurses and nursing extenders? Both Aiken and Needleman found that decreases in adverse outcomes were related to registered nurse staffing alone. Increases in licensed practical nurse hours or the use of nurses' aides had no effect on any patient outcome. In another study, Aiken found that nurses' education level was also inversely correlated with patient mortality. Results of other studies have been mixed."

In this research article, no explicit conceptual or theoretical framework was mentioned or explored in any meaningful way. The intent of the research was to create a new model that transcended previous data available at that time. The researchers appeared to base their work on the relationship between financial considerations and legislative bodies. The framework of this study seemed to shape the authors' arguments by reducing the problem of nurse-to-patient staffing ratios to a monetary figure.

Conclusion