Understaffed Nurses Linked to Higher Deaths and Readmissions (JAMA Study)
- A new study out of Japan found that nurse understaffing was linked with significantly poorer patient outcomes.
- Nurse understaffing led to higher rates of patient deaths, readmissions, and longer patient stays.
- The findings applied to both day and night shifts, with higher negative outcomes when day shifts were understaffed.
Image Source: SJ Objio
A new retroactive review out of Japan reaffirms what past nursing studies in the U.S. and other countries have found: understaffing nurses leads to poor patient outcomes, including higher mortality and readmission rates.
The findings were published in JAMA Network Open after researchers examined 77, 289 hospital admissions, analyzing data from both day and night shifts.
The conclusions? Nurse understaffing hurts patients across shifts, with day-shift shortfalls driving the highest risks of death and readmissions, while evening/night understaffing mainly extended patient stays.
The Staffing Study
While previous studies have looked at how nurse staffing levels can affect patient outcomes, this review aimed to specifically analyze the impact of nurse understaffing.
The researchers noted that studies that have linked adequate nurse staffing with positive outcomes may not be enough to specifically prove that negative outcomes can happen with understaffing.
Additionally, researchers wanted to analyze the impact of understaffing on each shift, day, and night, and how understaffing correlates with outcomes for each.
The study ultimately concluded that nurse understaffing had impacts on both day and night shifts, but day shift understaffing in particular was associated with:
- A higher risk of in-hospital mortality
- Higher rates of hospital readmission
- Longer patient stays
What the Study Means for Nurses
Study researchers admitted that despite data that proves adequate nursing staffing positively impacts patient outcomes, there isn't an easy way to set nursing staffing ratios, because of factors like budgets, patient acuity, and other floor resources.
Additionally, staffing ratios may not account for shift differences, so the study hoped to analyze the difference between the night vs. day shifts to help nursing managers guide staffing guidelines.
A Call for Change
The study's findings may not be surprising to a lot of nurses, because they mirror past studies, such as the 2002 California study that linked nurse understaffing to higher patient mortality, as well as negative impacts for nurses, like more burnout and job dissatisfaction.
A similar study out of Japan in 2008 also found that nurses themselves reported higher levels of "poor or fair quality care" when they were understaffed.
The bottom line is that this study reaffirms what nursing leaders already know: understaffing is dangerous, bad for patients and nurses, and leads to higher healthcare costs.
Commentary on the latest study called for "policy change" and noted that it was "discouraging, although typical," that change hadn't already happened in Japanese hospitals in light of the past data and studies that have previously shown the dangers of nurse understaffing.
Karen B. Lasater, PhD, RN, and Linda H. Aiken, PhD, RN, of the University of Pennsylvania in Philadelphia, noted that studies like this one out of Japan show how important adequate staffing is, yet countries that see nurses as a "cost" rather than an asset continue to miss the mark.
"Evidence on the association between hospital nurse staffing levels and patient outcomes continues to grow in jurisdictions across the world," they concluded. "When, if ever, will there be enough evidence to justify the use of tested policy levers to address chronic nurse understaffing in hospitals and other health care settings, even in high-income countries like Japan and the US?"
🤔Nurses, what do you think about these latest findings on nurse understaffing? Share your thoughts below.
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