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Adding just one extra full-time RN to hospital nursing units would significantly reduce deaths, a new review concludes, but savings from reduced lengths of stay wouldn't offset the costs of the added staffing. So the case for an extra nurse must hinge on improved image and liability risks for the hospital.


The review evaluated results from 27 studies to determine if a link exists between a hospital's patient/RN ratio and patient outcomes. Per shift, patient/RN staffing averaged about 3:1 in intensive care units (ICUs) and 4:1 in surgical and medical units. Researchers found a definite link between a greater number of RNs on staff and reduced deaths and other negative outcomes.


Researchers found that by adding one full-time RN in a unit per day, there were 9% fewer hospital-related deaths in ICUs, 16% fewer deaths among surgical patients, and 6% fewer deaths among medical patients. For every 1,000 hospitalized patients, an increase of one full-time RN per day could save lives at a rate of five in ICUs, six in surgical units, and five in medical units, researchers estimate.


Other benefits of employing one more nurse include lower rates of hospital-acquired pneumonia, respiratory failure, and cardiac arrest. And patient lengths of stay would be 34% shorter in ICUs and 31% shorter in surgical units. "Nurses are crucial to providing high-quality care," the researchers write.




Kane RL, et al., The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis, Medical Care, December 2007.