Just one more RN can save lives

If hospitals added one more full-time registered nurse (RN) on staff to care for patients, the number of hospital-related deaths in the United States could decrease significantly, according to a new review that also acknowledges adding one more RN isn't as easy as it sounds.

The report is the result of a systematic review aimed to examine whether there was a link between a hospital's registered nurse-to-patient ratio and the health outcome of the patients under their care, says lead author Robert Kane, MD, a patient safety researcher at the Univer-sity of Minnesota School of Public Health in Minneapolis.1 The results are clear, he says, but that doesn't mean health care administrators will rush right out to hire more RNs.

"The issue is not making them aware of the possibility; it's convincing them that it is in their best interests to act on it," Kane says. "From a business perspective, the savings in reduced lengths of stay would not offset the costs of the added staffing. The case would have to be made in terms of image and liability."

The researchers evaluated 27 studies of patient outcomes in relation to the registered nurse-to-patient ratio. Per shift, RN staffing averaged about three patients per RN in intensive care units, four patients per RN on surgical units, and four patients per RN for medical patients. The studies included in the review used data on patient outcome rates from sources such as the Uniform Health Discharge Data Sets and Centers for Medicare and Medicaid Services databases.

16% fewer surgical deaths

Kane and fellow reviewers found that a greater number of RNs on staff was associated with a reduction in the number of hospital-related deaths and other negative outcomes. Their results showed that by increasing the number of full-time RNs on staff per day by one, there were 9% fewer hospital-related deaths in intensive care units, 16% fewer in surgical patients and 6% fewer deaths in medical patients.

For every 1,000 hospitalized patients, the reviewers estimated that an increase by one full-time RN per patient day could save five patient lives in intensive care units, five lives on medical floors and six surgical patient lives.

Kane acknowledges that while increased nurse-patient ratios can lead to better patient outcomes, it is difficult to maintain a reasonable number of RNs on staff in light of the current shortage of available RNs. [Editor's note: Contact Krane at (612) 624-1185 or kanex001@umn.edu.]


1. Kane RL, Shamliyan TA, Mueller C, et al. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 2007; 45:1,195-1,204.