Presentation (CTI)

OBJECTIVES: States in the U.S. and internationally increasingly propose minimum nurse staffing legislation that would require hospitals to staff enough nurses for safe patient care. The Pennsylvania Patient Safety Act (HB 106) passed the House of Representatives in 2023 with bipartisan support, but leadership did not call for a Senate vote. To inform policy discussions underway, the objective of this study was to determine the hospital nurse staffing variation in Pennsylvania (PA) hospitals and associations with patient care and nurse job outcomes, and potential cost offsets.
METHODS: Cross-sectional study using data on nurse staffing from the 2023 Penn Nurses4All study linked and merged with the PA Health Care Cost Containment Council patient outcomes data. The independent variable was medical-surgical nurse staffing ratios. Patient outcomes included 30-day mortality, 30-day readmissions, and length of stay. Nurse outcomes included burnout, job dissatisfaction, and intent to leave. Costs were estimated for avoided nurse turnover and patient hospital days.
RESULTS: The sample included 547,689 patients and 2,782 direct care nurses in 132 PA hospitals. Hospital nurse staffing ranged from 3 to 9 patients per nurse (average 5.9). Each additional patient per nurse was associated with higher odds of 30-day mortality (aOR 1.08, 95% CI 1.03, 1.13, p<.001), longer length of stay (aIRR 1.02, 95% CI, 1.00, 1.04, p<.05) and higher odds of readmission (aOR 1.04, 95% CI 1.01, 1.07, p<.05). Higher nurse staffing ratios were associated with higher odds of nurse burnout, job dissatisfaction, and intent to leave. If all PA hospitals met a 4:1 nurse staffing ratio, an estimated 1,087 nurse departures would be avoided, resulting in $66,426,570 in annual PA cost offsets. Approximately 77,591 hospital days would be avoided, resulting in $239,057,871 in cost offsets.
CONCLUSIONS: A state policy establishing minimum safe nurse staffing requirements in hospitals is in the public’s interest.