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Nurse Staffing Costs Must Be Weighed Against Cost of Errors

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by NRSKarenRN NRSKarenRN, BSN (Guide) Guide Expert Nurse

NRSKarenRN has 40 years experience as a BSN and works as a Registered Nurse, Home Health.

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nursing perspectives:

rebecca hendren, for healthleaders media, august 30, 2011

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. it's time we change the way we think about hospital staffing.

"when we look at all the problems we have [in healthcare right now], what is the first thing we do? start slashing nurses," says kathy douglas, mha, rn, president of the institute for staffing excellence and innovation, cno of api healthcare, and a board member of the journal nursing economic$, which has devoted a whole issue to examining the evidence around nurse staffing.

"healthcare executives and nurse leaders need to be more aware of thinking about staffing and scheduling from a bigger perspective so we understand all of the financial implications," she says. "how do we manage our way effectively through the maze and chaos we are in right now?"

to deal with ongoing challenges presented by value-based purchasing and healthcare reform, executives must acquaint themselves with studies demonstrating how nurse staffing affects a hospital's overall performance and base staffing decisions on evidence.

"what we know from research and experience is that there are very direct links between staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover," says douglas. "all of these things have studies that directly relate them to staffing. and all have the potential for significant costs. when we don't look at the relationship between our los and our unreimbursed never events and our staffing, we're not looking at the whole picture."

too few hospitals track staffing data in comparison to these big issues.

...soft costs have hard financial implications. value-based purchasing has already put real money behind patient satisfaction. to make the link to staffing research and why it matters, we have to stop looking at staffing numbers in isolation. until we look at the whole picture, which includes everything associated with staffing, we're not going to understand financial performance.

"staffing costs sit in one part of the budget, so we think of the results there," says douglas. "then the cost of errors sits in another part of the budget. if i could say one thing to healthcare executives it is to make staffing a top strategic priority in your organization. if you look at top priorities--los, safety, quality--all of these things have direct links to staffing."

an organization that has cut back on staffing may not notice that it is overusing overtime and not notice that there's a relationship between the overtime and the number of infections on a unit...

Edited by NRSKarenRN

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57 Likes; 3 Followers; 33,556 Visitors; 4,124 Posts

Pathetic to have to bring money into the equation, pathetic tht we don't just value life and health enough to strive for them regardless of cost, using our innate good sense.

Shameful, just shameful.

At least someone is leading the way with this article's approach.

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13,402 Visitors; 728 Posts

That should all be common sense to everyone, but it's not! Why? Why? Why?

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13,628 Visitors; 1,530 Posts

Pathetic to have to bring money into the equation, pathetic tht we don't just value life and health enough to strive for them regardless of cost, using our innate good sense.

Shameful, just shameful.

At least someone is leading the way with this article's approach.

Even in government run healthcare, you can't just go willy nilly on cost. SOMEONE has to pay for the service, whether it is the patient, insurance or the taxpayer.

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mama_d has 10 years experience and works as a tele/oncology.

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I've been saying for a long time now that it's like the job Edward Norton's character does in "Fight Club"...how few nurses can we employ before the costs due to safey issues and lawsuits negates the savings?

Sad to realize that TPTB aren't even that far yet, they're apparently leaving half the equation out.

Even sadder that us lowly, undereducated floor nurses could have told those PhD/MBA types all this long long ago.

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Re: staffing costs vs. the cost of errors.

Poor nurse staffing leads to rising hospital-acquired illness in US

According to a recent study by the Agency for Healthcare Research and Quality (AHRQ), “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.” Major factors that contribute to lower staffing ratios 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.

Elaborating on the adverse affects of poor staffing, Amy said, “The reality is that hundreds and thousands of patients die, and it costs our nation $3.4 billion a year to take care of bad care—not good care—bad care. That’s from admission to discharge,” she said. “That doesn’t include rehab.”

“Say, for example, you go to the hospital and contract MRSA [Methicillin-resistant Staphylococcus aureus, a bacterial infection that is difficult to treat] and you get really sick and go to the ICU, and because you’re in the ICU you get debilitated and can't walk so you have to go to rehab—we only can measure the amount of money spent to take care of you during that acute care stay. It doesn’t include the rehab and all the follow-up care. That’s $3.4 billion a year. If we did what it took to stop making people sick—look at the money we would save. Spend a little on hiring more nurses to save a lot—not only in money but in lives.”

When asked why hospitals don’t have better staffing ratios, Sue explained, “They’re always making cuts and it always falls to the nurses to make sacrifices, but at my facility they recently hired a new executive and it has been three years since we’ve had a raise. My facility not only hired a new executive, they created a new management position called Senior Executive Director in addition to the Executive Director. Meanwhile, all other staff have gone without pay raises for three years. We’re taken advantage of every day.”

Pneumonia rates are especially sensitive to staffing levels. AHRQ concludes that:

• Adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by 4 percent;

• Fewer RN hours per patient day were significantly correlated with higher evidence of pneumonia;

• An increase of one hour worked by RNs per patient day was associated with an 8.9 percent decrease in the odds of a surgical patient contracting pneumonia; and,

• A 10 percent increase in RN proportion was associated with a 9.5 percent decrease in the odds of pneumonia.

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oramar works as a returned nurse.

1 Article; 32,278 Visitors; 5,758 Posts

This is so obvious to everyone but healthcare management. Why is it necessary to point out the obvious to people who should be the first to know not the last?

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lindarn works as a RN.

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Folks,

It is NOT just money. It is CONTROL OF THE NURSING PROFESSION!! As long as they can keep nurses moving from job to job, no one stays long enough to make an effort to change things for the better (unionizing). It is the same situation in nursing homes. Make that, it is worse in nursing homes.

Anyway, this is a calculated move on their part. This is the name of the game.

JMHO and my NY $0.02.

Lindarn, RN,BSN, CCRN

Somewhere in the PACNW

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wooh works as a RN & Critter Mama.

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This is just silly. You know if us nurses would just quit making mistakes and quit spreading germs, the administrators could have their cake and eat it too!!!

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elprup has 2 years experience and works as a Soul searching..

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I'm copying this article and leaving it for my director. Thanks!

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Tankweti works as a LTC Charge Nurse.

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Just like so many things nowadays, upper management is rolling the dice and hoping that nothing bad will happen to a patient that can be traced back to unacceptable staffing levels. This is why facilities only want experienced nurses rather than new grads. Yes, it is about the money and time involved to train new grads (who may not stay because they thought nursing was something other than what it is). But it is, in my view, also about the fact that facilities are now placing higher patient loads on what few nurses they do have and, in order not to have safety completely fly out the window, those nurses that they do have need to be experienced to handle those higher patient loads. If your resources are so thinly stretched, then you have zero room for error.

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