More Nursing Hours Better, Except Overtime

Photo of nurse's cap by BrokenSphere (Wikimedia Commons).

An interesting study of nurse staffing levels concluded that more non-overtime nursing is good for patients and the hospital’s bottom line, but having nurses work more overtime hours is bad for both.

Huh? At first glance I wondered how that could be. Aren’t more nursing hours better for patients, regardless of when nurses work? The investigators attributed the results in part to better care and patient education from more nurses working non-overtime schedules but a negative effect from stress and fatigue the more overtime hours increased.

The study looked at 1,892 medical/surgical patients in 16 nursing units at four acute-care hospitals in 2008. The probability of patient readmissions within 30 days after discharge was 44% lower for each extra 45 minutes of non-overtime nursing care per patient per day. Higher nurse staffing levels meant less need for overtime work, and lower overtime was associated with a lower likelihood of patients making unplanned visits to emergency departments after discharge. With higher overtime hours, the odds of unplanned emergency visits after discharge increased by 70%, Marianne Weiss, D.N.Sc. of Marquette University College of Nursing, Milwaukee, Wisc. and her associates reported in a study published online by the journal Health Services Research.

When nurse staffing levels were high, patients were more likely to report satisfaction with what they were taught about managing their condition after discharge, and to say they felt well prepared and “ready” for discharge.

Of course, nurses cost money. But so do overtime, readmissions, and emergency visits. A cost analysis included in the study makes a business case for hospitals to fund sufficient, high-quality nursing staff, Matthew McHugh, Ph.D. said in a statement released by the Health Behavior News Service, part of the Center for Advancing Health. Dr. McHugh is of the Center for Health Outcomes and Policy Research at Pennsylvania School of Nursing,Philadelphia.

The investigators estimated that if the 16 nursing units in the study increased non-overtime nursing care by 45 minutes per patient per day, cumulatively they could save more than $11.6 million each year in patient costs and another $544,000 per year due to decreased overtime pay.

So, it’s not as simple as “more is better” when it comes to nursing. More rested, alert nursing care, yes. More tired, stressed nursing care – not so much.

The Robert Wood Johnson Foundation funded the study.

–Sherry Boschert

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