Hiring more nurses can save money in the long run
It may seem counterintuitive to suggest hiring more nurses when a health care provider already is struggling with tight budgets and a bad economy, but some experts say increased nursing staff can yield significant patient safety improvements that will more than pay for the personnel costs. The key, they say, is to look beyond the initial expenditure to the savings that accrue downstream.
The connection between nurse staffing and patient safety has been well established. The American Association of Colleges of Nurses reports that an increase in RNs contributes to a decrease in hospital-related mortality and reduced lengths of patient stays, whereas inadequate staffing is known to compromise patient safety. Robert Kane, MD, professor and Minnesota chair in long-term care and aging at the University of Minnesota School of Public Health, says his research has shown that if hospitals add just one more full-time registered nurse on staff to care for patients, the number of hospital-related deaths could decrease significantly.
The challenge is in making hospital administrators see past the initial costs, Kane says.
"The issue is not making them aware of the possibility; it's convincing them that it is in their best interests to act on it," he says.
Factor in image, liability
From a business perspective, the savings in reduced lengths of stay would not offset the costs of the added staffing, Kane says, but balance comes when you factor in image and liability, he says. For every 1,000 hospitalized patients, an increase by one full-time RN per patient day could save five patient lives in intensive care units, five lives on medical floors, and six surgical patient lives, he says.
Connecting patient safety to savings in liability is the next logical step, suggests Peter Anderson, MD, clinical assistant professor of family medicine at the University of Virginia School of Medicine and assistant professor of clinical family and community medicine at Eastern Virginia Medical School in Norfolk.
Anderson has created and implemented a new office model for physicians that is being picked up nationwide and requires doctors to hire more nurses than average, and he says the benefits greatly exceed the expense. Studies of his office model show improved quality of care. For instance, with more nurses, medical history charts have improved, and Anderson now focuses on treatment plans. Anderson also reports that hiring more nurses can increase patient capacity, facilitate a more efficient system, reduce waiting room times, and increase revenue collections. (Editor's note: For more on Anderson's model and the potential benefits, see this web site: http://www.familyteamcare.org/ftc-benefits-and-outcomes.html.)
After practicing for 25 years, Anderson found in 2003 that his practice was struggling financially, yet he had to turn away patients because he didn't have the time to see them. So, in an effort to become more efficient, Anderson hired an additional nurse.
"You usually hear that the electronic medical record is the key to efficiency, or that you should have more office staff, or more physician assistants. I found those things are important, but they're a Band-Aid if you don't have enough nurses," he says. "Hiring more nurses has exponentially more impact on efficiency, safety, and quality than any of those other factors ever can achieve."
Theory applies well in hospitals
Since then, Anderson has shown hospitalists the same philosophy and now is a strong advocate of hiring more nurses in the hospital setting. The benefits in documentation are particularly strong, Anderson says.
"We all live and die by that hospital record, and when we have enough nurses working with patients, we end up with a more accurate, reliable record," he says. "The doctor has so much administrative responsibilities, especially with reimbursement, that you can spend two-thirds of your time on that and one-third on patient care. So, the physician might not document well and pay for it later."
Anderson had his nurses take over more of the administrative tasks related to the patient visit, expanding their capacity to oversee medical issues of the patient.
"My nurses love it, because you're letting them do more of what they are trained to do. They go in and take a history of the patient, which is one of the most time-consuming things a doctor does," Anderson says. "We train nurses in the hospital to take on the same tasks, and they appreciate being able to do more of [what] they went to nursing school for. That, in turn frees the doctor to concentrate more on what he or she went to medical school for. The patient benefits in the end."
Anderson hired more nurses purely for financial reasons, but he says he was pleasantly surprised to see a significant increase in quality and patient safety. The same can hold true in hospital settings, as well, says Mick Whitley, president and managing director of HCL International, a health care recruiting firm in New York City.
Adequate nursing staff improve continuity of care, Whitley says, and help avoid the many risks associated with temporary and transient staff.
"There are a number of problems that can arise when a provider tries to get by with just the minimum staffing and then has to fill in here and there with temporary staff," he says. "There is a good deal of research showing that temporary staff are more involved with medication errors, handoff errors, and generally have a detrimental effect on patient safety. There can be serious problems with communication between staff members if they are not there all the time."
When there are too few nurses, the nurses who are there tend to be overworked, Whitley says. That, in turn, threatens patient safety. And then a provider can find itself in a downward spiral when the nurses grow dissatisfied with their working conditions and the hospital finds it increasingly difficult to recruit new nurses. That results in hiring more temporary staff, which then just perpetuates the problem.
"We're seeing some providers shy away from hiring more health care staff because of the economy, but that can be a mistake if you do not factor in the potential results down the road," Whitley says. "Administrators can be looking at the budget side of things for the short term, but ignoring what might happen if you have an overworked work force who don't have enough time to spend with patients. You may reduce your expenses right now, but in six months' time, when there has been an increase in complaints and medical errors, you may see your error."
Sources
For more information on the cost-effectiveness of hiring more nurses, contact:
Peter Anderson, MD, Family Team Care, Newport News, VA. Telephone: (866) 829-8989.
Mick Whitley, President and Managing Director, HCL International, New York City. Telephone: (212) 984-0612. E-mail: [email protected].
It may seem counterintuitive to suggest hiring more nurses when a health care provider already is struggling with tight budgets and a bad economy, but some experts say increased nursing staff can yield significant patient safety improvements that will more than pay for the personnel costs. The key, they say, is to look beyond the initial expenditure to the savings that accrue downstream.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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