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More Nurses Can Mean Better Care at Same Cost, Study Says

JANUARY 10, 2006 -- Increasing hours of nursing care could save lives, shorten hospital visits, and prevent medical complications, according to a new study that appears in the January/February issue of Health Affairs.

The article examines the health outcomes and costs that could result from raising the proportion of registered nurses (RNs) and hours of nursing care per patient. The study concluded that increasing the proportion of RNs improves care without raising costs and that increasing the number of nurses improves care at a price.

The study examined three possible approaches to improving nursing care:

  • Increasing the proportion registered nurses without changing the number of nursing care hours per patient.
  • Increasing the number of nursing care hours per patient without changing the proportion of registered nurses/licensed practical nurses.
  • Raising both the proportion of RNs and the number of nursing care hours.

The study concluded that the first option would improve care and could also save money by reducing deaths, shortening hospital stays, and preventing hospital-related complications such as pneumonia and urinary tract infections. An estimated 37,000 RNs would have to be hired to replace the licensed practical nurses at a cost of about $811 million, but long-term savings are estimated at $1.8 billion.

The other two options would not pay for themselves, but the authors believe the changes are worth the price.

"We would have to spend more money, but the value to patients makes it look like it is worth doing," said author Jack Needleman, associate professor at he University of California at Los Angeles.

The costs associated with the second and third options are significant, $5.8 billion and $5.7 billion, respectively, equivalent to approximately 1.5 percent of annual hospital expenditures. Annual hospital inflation is approximately 5 percent to 6 percent.

Licensed practical nurses (LPNs), also known as licensed vocational nurses, have about two years of training. Registered nurses have more training and are able to evaluate patients and provide care at a more sophisticated level. They are generally paid a third more money than LPNs.

"If the wages rose and working conditions improved," the first option could be implemented, said study coauthor Peter Buerhaus, professor and senior associate dean for research at Vanderbilt University School of Nursing.

But the second and third options would require well over 100,000 nurses, more nurses than are currently available.

Buerhaus attributes the dearth of nurses to shortages in nursing faculty, space in nursing schools, and space in clinical programs. Despite the need for nurses, nursing schools were turning prospective students away last year, he said.

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