ArticleBMJ quality & safety2021
Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients.
Article in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Psychological responses of hospital-based nurses working during the COVID-19 pandemic in the United States: A cross-sectional study.Applied nursing research : ANR · 2022Pooled it
- Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.Medical care · 2026Observational
- Association of Emergency Department and Medical-Surgical Nurse Staffing on Patient Departures Against Medical Advice.Journal of emergency nursing · 2026Article
- Impact of nurse staffing coverage and care complexity factors on health outcomes in hospitalized COVID-19 patients: a cross-sectional study.BMC nursing · 2025Article
- Regulatory landscape for pediatric hematology-oncology nursing in Brazil: document analysis of policies and regulations.Revista panamericana de salud publica = Pan American journal of public health · 2025Article
- Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study.International journal of nursing studies · 2024Article
- Nurse understaffing associated with adverse outcomes for surgical admissions.The British journal of surgery · 2024Article
- Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study.BMJ open · 2024Article
- "Not what we signed up for": Nurse shortages, physician scarcity, and time for collective bargaining?World medical & health policy · 2024Article
- A Review of Disparities in Outcomes of Hospitalized Patients with Limited English Proficiency: The Importance of Nursing Resources.Journal of health care for the poor and underserved · 2024Review
- Explaining racial disparities in surgical survival: a tapered match analysis of patient and hospital factors.BMJ open · 2023Article
- Matching One Sample According to Two Criteria in Observational Studies.Journal of the American Statistical Association · 2023Article
- Hospital nursing factors associated with decreased odds of mortality in older adult medicare surgical patients with depression.BMC geriatrics · 2022Article
- The association between hospital nursing resource profiles and nurse and patient outcomes.Journal of nursing management · 2022Article
- Cost-Effectiveness Analysis of Improving Nurses' Education Level in the Context of In-Hospital Mortality.International journal of environmental research and public health · 2022Article
- A Brief Theory Critique: The Theory of Moral Reckoning.Journal of nursing doctoral students scholarship · 2022Article
- Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment.AACN advanced critical care · 2021Article
- Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study.BMJ open · 2021Observational
- Chronic hospital nurse understaffing meets COVID-19: an observational study.BMJ quality & safety · 2021Observational
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundThere are known clinical benefits associated with investments in nursing. Less is known about their value.
aimsTo compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks.
methodsRetrospective matched-cohort design of patient outcomes at hospitals with better versus worse nursing resources, defined by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses and nurse work environments. The sample included 62 715 pairs of surgical patients in 76 better nursing resourced hospitals and 230 worse nursing resourced hospitals from 2013 to 2015. Patients were exactly matched on principal procedures and their hospital's size category, teaching and technology status, and were closely matched on comorbidities and other risk factors.
resultsPatients in hospitals with better nursing resources had lower 30-day mortality: 2.7% vs 3.1% (p<0.001), lower failure-to-rescue: 5.4% vs 6.2% (p<0.001), lower readmissions: 12.6% vs 13.5% (p<0.001), shorter lengths of stay: 4.70 days vs 4.76 days (p<0.001), more intensive care unit admissions: 17.2% vs 15.4% (p<0.001) and marginally higher nurse-adjusted costs (which account for the costs of better nursing resources): $20 096 vs $19 358 (p<0.001), as compared with patients in worse nursing resourced hospitals. The nurse-adjusted cost associated with a 1% improvement in mortality at better nursing hospitals was $2035. Patients with the highest mortality risk realised the greatest value from nursing resources.
conclusionHospitals with better nursing resources provided better clinical outcomes for surgical patients at a small additional cost. Generally, the sicker the patient, the greater the value at better nursing resourced hospitals.
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