Team nursing could lead to patient deaths, higher costs, says study

Replacing registered nurses with non-RN staff is dangerous to patients, according to a new study from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing published in Medical Care.


To assess how the struggle to recruit and retain hospital nurses affects patients, researchers looked at data on patient outcomes, 30-day mortality rates, 30-day readmissions, length of stay and patient satisfaction at 2,676 general acute care U.S. hospitals in 2019.

After conducting a cross-sectional analysis of three linked datasets from the American Hospital Association Annual Survey, Medicare Provider Analysis and Review patient claims and Hospital Compare’s Hospital Consumer Assessment of Healthcare Providers and Systems, the researchers said they found the staffing ratio reductions translated to 11,000 deaths and increased avoidable Medicare costs.

Most hospitals they studied had more than 70% RNs in their total nursing staff. 

However, “we can project from our models that a 50 percentage-point reduction in RNs, from our observed average of 76.5% RNs, would be associated with 38% higher odds of in-hospital mortality, 24% higher odds of 30-day mortality, 6% higher odds of readmission and a 10% increase in the expected length of stay,” they said in the abstract.

Further, a 10-percentage point reduction in RNs translates to $68.5 million in avoidable costs paid by Medicare, they said.

“Estimates represent only a 10 percentage-point dilution in skill mix. However, the team nursing model includes much larger reductions of 40–50 percentage points – the human and economic consequences of which could be substantial.”


Nationally, nurse groups are concerned about nurse-to-patient ratios and oppose laws requiring minimum nurse staffing ratios, arguing risks to patient care.

Nurses at Ascension Saint Agnes Hospital in Baltimore, Maryland, rallied on Thursday in support of staffing protections proposed to hospital management during its recent contract negotiations, according to National Nurses United.

“Ascension’s pattern of closing obstetrics and labor and delivery services around the country, we believe these ‘Patients First’ protections need to be ensured through our contracts,” Nicki Horvat, a neonatal intensive care nurse and member of the bargaining team, said in a statement.

NNU also said its January report found that Ascension cut a quarter of its labor and delivery units in the past decade, impacting metropolitan and other areas with higher rates of low-income, Black and Latino patients at a time when pregnancy- and childbirth-related mortality rates were rising.


“Reducing the proportion of RNs in hospitals, even when total nursing personnel hours are kept the same, is likely to result in significant avoidable patient deaths, readmissions, longer lengths of stay and decreased patient satisfaction, in addition to excess Medicare costs and forgone cost savings to hospitals,” the researchers said.

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS Media publication.

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