New research in Medical Care found that hospitals opting to replace registered nurses with non-RN staff could be sacrificing patient safety for short-term financial gains.
This was one of the largest-ever studies investigating the tradeoff between RNs and lower-wage labor, yet it received surprisingly little coverage given the implications of its findings.
UPenn researchers analyzed clinical and claims data for 6.5 million Medicare patients across 2,676 US hospitals in 2019, finding that every 10 percentage-point reduction in RNs was associated with:
- 7% higher odds of in-hospital death
- 1% higher odds of readmission
- 2% increase in expected days
- “Significantly” lower patient satisfaction
Hospitals are often pressured to pursue “team nursing” models for the immediate financial lift of substituting RNs with nurses’ aides or licensed practical nurses, but the authors warn that the true impact of using less skilled workers is likely the exact opposite.
- The study estimates that a 10 percentage-point reduction in RNs would result in nearly 11k avoidable deaths annually and 5,207 preventable readmissions.
- That translates into roughly $68.5M of additional Medicare costs each year, with hospitals also losing nearly $3B annually because of patients requiring longer stays.
Then why do hospitals continue substituting RNs with lower-wage staff? From the patient perspective, the negative impact on outcomes – let alone mortality – should stop the idea of lowering the skill-mix in its tracks.
- That said, the average hospital sees an instant cost reduction of $31.94 per patient day for every 10 percentage-point reduction in RNs to total nursing staff.
The financial near-sightedness of that $31.94 cost reduction blinds hospitals to an estimated $66.03 of lost revenue per patient day for the same 10pp reduction in skill-mix… in other words the expected ROI is more than a two-fold loss.
The Takeaway
Nursing budgets are a huge slice of the hospital expense pie, making them a go-to target when leadership teams are looking to make cuts to fund other areas. This study reaches the paradoxical conclusion that the reason hospitals don’t have funds for other areas could be because they aren’t investing enough in the nurses they’re thinking of cutting.
