Reducing Chile's Staffing Average of 14 Patients Per Nurse Would Result in Better Care

Limiting staffing to no more than 10 patients per nurse would have health and financial benefits, Penn study says.

Establishing safe nurse staffing standards in hospitals in Chile, where some patient-to-nurse ratios reach as high as 24 patients per nurse, could save lives, shorten hospital stays, and reduce readmissions, says a new study conducted, in part, by the University of Pennsylvania School of Nursing.

The study, which adds to a body of research that supports safe nurse staffing levels, was led by renowned nurse academic, Linda H. Aiken, PhD, RN, professor and founding director of the Center for Health Outcomes and Policy Research at Penn, in partnership with the Chile School of Nursing at the University of the Andes. The study was published in The Lancet Global Health.

Researchers looked at 40 hospitals throughout Chile and found large variations in patient-to-nurse staffing, which was significantly better in private hospitals versus public hospitals.

Lower staffing levels in public hospitals were found to be associated with avoidable deaths and higher-than-necessary costs, according to the study.

"Nursing has been overlooked in Chile as a solution to healthcare quality and access problems," Aiken says. "This study shows investments in improving hospital nurse staffing would result in higher quality of care and greater productivity which could improve access to public hospitals."

The researchers collected extensive data from 1,652 nurses practicing in 40 Chilean complex general acute hospitals and analyzed outcomes for more than 761,948 patients. They found:

Nurse staffing in Chilean hospitals is much worse than international standards. On average, nurses in Chilean hospitals care for 14 patients each, compared to 5 patients each in the United States, where legislation sets safe nurse staffing standards. Some public hospitals have patient-to-nurse ratios that reach as high as 24 patients per nurse.

Variation in hospital nurse staffing results in avoidable deaths. Patients in hospitals where nurses were responsible for 18 patients each had 41% higher risk of death compared to patients in hospitals where nurses cared for eight patients each.

Better hospital nurse staffing would reduce costs of care enough to fund additional needed nurses. In poorly nurse-staffed hospitals, the average length of stay was significantly longer and more patients were readmitted after discharge because of complications. Improving nurse staffing to 10 patients per nurse could save more than $29 million USD annually from avoided hospital days. That savings would more than pay for the costs of employing the 1,118 additional nurses needed.

Availability of hospital beds was adversely affected by poor nurse staffing. If Chilean public hospitals staffed at levels where nurses cared for no more than 10 patients each, more than 100,000 days of inpatient care could be avoided annually from shorter stays and reduced readmissions, resulting in reducing hospital admission waiting lists.

Chile has a sufficiently large supply of nurses to staff hospitals at much improved levels. Chile has an excellent nurse education system which graduates more than 6,000 nurses a year, all with bachelor’s degrees.

"The findings from this study suggest that Chile has the resources and the means," says Marta Simonetti, PhD, RN, the lead researcher at the University of the Andes, "to improve nurse staffing in public hospitals to enhance access to high-quality hospital care in the country."