Low Nurse-to-Patient Ratios: Do They Save Money?

California instituted nurse-to-patient ratio legislation in 2004 and one of the pro/con debates was whether mandating this measure would be costly for hospitals.

Well, studies say yes and no.

A new study by the federal Agency for Healthcare Research and Quality found that wages for registered nurses working in California increased by more than the wages of nurses in states without similar regulations. (The study appeared in the journal Health Affairs.)

But, a year ago, the California Nurses Association and the National Nurses Organizing Committee posted a list of studies that, overall, concluded that the nurse-to-patient ratio laws probably do save money in the end.

Here are some of those studies and the publications in which they appeared:

■ RN understaffing in hospital ICUs increases the risk of pneumonia and other preventable infections that can add thousands of dollars to the cost of patient care— Critical Care, 2007.
■ Raising the proportion of RNs by increasing staffing to match the top 25 percent best staffed hospitals would produce net short-term cost savings of $242 million — Health Affairs, January/February 2006.
■ Improving nurse-to-patient ratios from 1-to-8 to 1-to-4 would produce significant cost savings and is less costly than many other basic safety interventions common in hospitals — Medical Care, Journal of the American Public Health Association, August 2005.
■ Johns Hopkins University researchers found that hospitals with fewer nurses in the ICUs during the night shift generated a 14 percent increase in costs — American Journal of Critical Care, November 2001.
■ Harvard researchers cited a 3 percent to 6 percent shorter length of stay for patients in hospitals with a high percentage of RNs — Nurse Staffing and Patient Outcomes in Hospitals, Harvard School of Public Health, 2001 report.
■ It costs hospitals about $42,000 to replace a general medical/surgical-unit RN, and $64,000 to replace a specialty RN — Journal of the American Medical Association, October 2002.

With the new legislation that denies payment by Medicare for hospital-induced medical problems like infections and pressure sores, it’s more important than ever to have adequate staffing. Without it, hospitals are sure to see their costs spiral upward and their collections head downward.

Does your state mandate nurse-to-patient ratios?

If so, how has it changed your job and workplace?

If not, do you think you could do a better job with lower nurse-to-patient ratios?

Are there any disadvantages to nurse-to-patient ratios?

Tell us about it.