It’s become increasingly popular for hospital systems to opt for overtime or third-party solutions to address chronic nursing staff shortages. Unfortunately, it’s also becoming increasingly apparent that those are expensive – and possibly life-threatening – stopgap solutions. Another new study confirms what a bevy of research has already suggested. Chronic hospital ward understaffing puts patients at risk. But it also costs the government more than it would to simply hire more nurses.
This latest research, from England’s University of Southampton, covered a span of five years and four National Health Service trusts, provides the strongest evidence so far that bridging these nursing shortfalls can save lives and money.
The study ties low nurse staffing levels to higher health risks, climbing readmission rates, and longer stays. But perhaps most importantly, it reveals that investing in adequate nursing levels – especially registered nurses (RNs) – could take some of the pressure off an already overburdened healthcare system.
The Hidden Costs of Not Enough Nurses
According to the paper, appearing in BMJ Quality & Safety, patients exposed to RN understaffing in the first five days of their hospital stay faced:
- A much higher risk of death.
- A greater likelihood of being readmitted.
- And notably longer hospital stays (1.687 times longer on average).
While support staff shortages also bumped up the risk of death and longer stays, they did translate to marginally lower readmission rates.
Ending Nurse Shortages is Cost-Effective
Using economic modeling, the British researchers looked at the cost-effectiveness of tackling staffing shortages from an administrative perspective.
It’s tough to argue with the results. Fully staffing hospital wards would cost £2,778 per quality-adjusted life year (QALY). That’s far lower than the £10,000 per QALY threshold set by the National Institute for Health and Care Excellence (NICE) for “exceptional value.”
When considering benefits such as fewer staff absences and reduced readmissions, the cost drops to £2,685 per QALY. Factoring in the shorter length of stay, eliminating understaffing could actually save hospitals £4,728 per QALY.
On the other hand, using agency nurses to plug staffing gaps remained much less effective – and more expensive – while targeting specific high-risk patient groups also proved less cost-effective than addressing the system-wide staffing problem.
A Vicious Cycle of Staffing Shortfalls
England’s NHS is enduring a 10.6% RN vacancy rate. That amounts to more than 43,000 empty posts. The unrelenting nursing shortage contributes to poor working conditions, which fuels higher turnover rates. It’s a vicious cycle that acts as a drag on staffing levels.
For years, hospitals have relied on provisional solutions, whether it’s pressuring staff to take overtime or relying on expensive agency staff. But these short-term solutions pale in comparison to simply hiring permanent, trained nurses.
At the same time, burnout – simultaneously a driver and a consequence of staffing shortages – remains the main reason nurses bail on the NHS. And it’s not a small problem. A recent YouGov survey found that nearly three-quarters of NHS staff say they’ve felt burnt out or exhausted “at least some of the time.”
Policy Implications
The researchers contend that the NHS must prioritize investments in permanent RNs. Unlike earlier studies, which typically relied on cross-sectional data or focused on a single site, this longitudinal, multisite breakdown ties patient outcomes directly to specific ward staffing levels. And despite its geographical constraints, the study’s authors insist the results apply to other publicly funded healthcare systems.
As the NHS faces mounting pressure to boost outcomes with smaller budgets, this data offers a clear message. Better nurse staffing isn’t just better for patients. It’s just good economics.
Further Reading
Nurse Shortage Drives Up Costs, Threatens Patient Safety
