Nurse Staffing Costs Must Be Weighed Against Cost of Errors

When revenues fall, hospitals stop investing in the biggest budget expense: nurses. That's a bad short-term solution to a long-term problem. Executives must acquaint themselves with studies demonstrating how nurse staffing affects a hospital's overall performance.

14 comments on "Nurse Staffing Costs Must Be Weighed Against Cost of Errors"
Mark (9/16/2011 at 4:59 PM)

"To do so, we need a better understanding of what the research shows about nurse staffing." The research continues to show that under staffing leads to errors, increases in infection rates and marginal care. What "better" understanding is it that we need? The need to "flex up" will only work in the unpredictable world of hospital nursing when the flex nurse is available immediately. Too often there's no one at all to do the flexing and the nurses are left runnig around like headless chikens, praying that no pt. will be harmed by shift's end.
Mike (9/14/2011 at 9:36 PM)

Bonnie, there was no mention of the staff being under educated. I believe the issue at hand was the lack of sufficient staffing, which, in turn, causes the remaining staff to be overbudened. Thus the errors and burnout.
Bonnie (9/7/2011 at 5:22 PM)

I agree that nurse staffing does effect issues such as infections, falls, med errors, etc. However far more than that, continued education and updating nurses on best practise does work. Include nurses in the quality one on one education of their peers has proven to be far more effective than online training. Involving the new grads in a concentrated quality education is very effective in preventing safety issues.
D. Cobler (9/6/2011 at 9:55 AM)

Nurses who work for hospitals don't seem to have enough time to just be nurses. They are expected to serve on (mostly) useless committees, many times use their off hours to attend educational activities required by the institution, try to keep current with CNE's as well as [INVALID]s with technology, and the list goes on. And we wonder why so many suffer from stress related illnesses.
Julie V. (9/6/2011 at 8:50 AM)

Hospitals are not the only ones affected by the revenue cuts. Nursing homes are also having to cut staff, continuing education and benefits to make ends meet. This poor management started in the 80s when the Bean Counters said, "Need more income, just give the nurse 5 more patients and cut her educational support." Why don't they cut other departments (like one too many administrators) and stop picking on the nurses?
Judith Pecho (9/4/2011 at 12:45 PM)

Now that hospitals for the most part are profit driven, administrators make outrageous salaries, and even small hospitals have two or three administrators. The best places I have worked were run by nuns, who placed sound priority on quality care. Patients are not widgets but complicated people under stress in most situation. To cut nurse/patient ratios is a crime. To expect staff with two months of training to oversee the patients every need, limiting minutes allowed for RN's for patient contact is worse than ignorant. It is intentional. As a RN, I hope I never have to go to the hospital. One thing about infection rates, it seems the limiting of RN's to supervise staff is a factor, as well as is the hospitals neglecting to culture all staff noses to identify the carriers of the MRSA bacteria. Those staff must wear nose and mouth masks when contacting any patient, or be assigned to a non-patient area. This would bring down the infection rate radically and would show results immediately.
kzathy z (9/2/2011 at 8:15 PM)

What I am seeing is that nursing is to involved in supply chain. If we can find a way to get nursing the supplies they need when they need them....what happens...better patient care...nursing satisfaction...captured revenue...better reportability the process begins to flow and the patient has a better experience.
Mark Stambovsky (9/2/2011 at 1:16 PM)

"Staffing costs are an issue because of the varables with volume, acuity, overtime, education, and the list goes on. Set the pay and set parameters about exceptable hours worked." You cannot "set parameters" of practice in nursing as if you were setting alarm values on a monitor. Bedside nursing involves too much variability and unpredictability. I can only assume you have not worked in such a capacity for any length of time.
Mark Stambovsky (9/2/2011 at 1:07 PM)

"At the same time, nurses need to realize that the quality of their work...are extremely important to their institution." Nurses are acutely aware of the critical role they play in patients' morbidity and mortality. Unfortunately, the public by and large does not. Sadly, executives persist in treating nursing as just another cost center that can be financially micromanaged without any appreciable fallout. But consistent superior patient care and nurse staffing micromanagement are incompatible. Flex staffing in theory is fine. But when there are either no nurses to be called in(either bonuses are not offered or staff has been cut) or management can simply decide that staff should "stick it out" until the end of yet another shift, flex staffing is meaningless. Admissions come when they is in the nature of the beast. It is not a "crisis" when many come at once. The only crisis is an artificial one created by those who "hope" it just won't happen too often. As long as hospitals staffing is such that nurses are forced to practice by the seat of their scrub pants, patient morbidity and mortality will be compromised and satisfaction scores will suffer. Perhaps when these scores affect reimburesment executives will finally change their perspectives.
christina hall (9/2/2011 at 11:43 AM)

As a former staff RN, cutting nursing staff ultimately leads to inferior patient care, with all that implies. This cannot be stressed strongly enough. Simply put, if you do not have adequate staffing based on the complexity of patient needs, you will be unable to deliver adequate care. I will no longer work at the bedside due to unsafe staffing ratios. We must find other ways to trim the budget.
Jack Malizzi RN (9/2/2011 at 10:31 AM)

Why don't we get further outside the box and ask all nurses to be salaried and rise to a professional level. Staffing costs are an issue because of the varables with volume, acuity, overtime, education, and the list goes on. Set the pay and set parameters about exceptable hours worked. We will see a dramatic shift in errors due to professionalism and in costs.
Todd Hinker (9/2/2011 at 9:57 AM)

Nursing Shortage? I am an an and have ben for 25 years, I have seen and experienced a nursing shortage. I totally agree with the concept of what you are saying, but in the area that we provide staffing, southern California, there is NO nursing shortage for the first time in 2 decades. Spot on Concept, your premise is wrong, there is no nursing shortage, at least not in all of Southern California.
Deanna Manuel (8/31/2011 at 8:38 PM)

I am so inspired to know that there are nurses out there whom care about the bottom line-staffing and quality of care instead of ratios and numbers. Safe staffing does matter, ask anyone whom has had surgery and may not get their needs met. Not meeting goals for patients increases the chances of bad outcomes. Bad outcomes create more costs for hospitals. Thanks for this article and letting the hospital leaders understand how safe nurse staffing affects the overall performance of the hospital.
Donald Wood (8/31/2011 at 4:31 PM)

While nursing has always been looked at as a cost center, times have changed. Though nursing is far from a revenue center, it has certainly become a revenue enhancer. Value based purchasing can either be up to a 2% loss for hospitals in Medicare reimbursement or a 2% increase. Other items mentioned in this article ($21 billion for never events) can not be ignored without the consequences being felt by the entire organization. The figure quoted for never events probably doesn't include the loss of standing the hospital has within its community. This will also translate into dollars as time goes on. (Note the recent news stories on Methodist and Parkland Hospitals in the Dallas, TX area.) At the same time, nurses need to realize that the quality of their work, both in hard and soft skills, are extremely important to their institution. Something as simple as a smile when entering a room can set the tone for a satisfied patient.


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