Nurse Staffing Ratios Tied to High Costs, Patient Safety Savings

A Massachusetts ballot question considering mandated nurse staffing ratios will cost the Commonwealth, hospitals, and other healthcare organizations because of increased staffing needs, according to an analysis from the Massachusetts Health Policy Commission (HPC). Should the measure pass, it could also yield cost savings associated with improved patient safety.

The ballot question asks whether healthcare organizations should be liable to nurse staffing ratios, meaning each provider would need to have a certain number of nurses per patient. Certain specialties or facility types would see different ratios based upon typical need.

Proponents of the ballot question say this measure will improve patient safety and reduce nurse burnout, while detractors say it could be costly and limit patient access to care should a hospital max out its nurse ratio.

The HPC report sought to understand the financial costs should the ballot measure pass. Overall, the Commonwealth and its healthcare facilities could face cost increases between $676 million and $949 million. These costs would stem from hiring more full-time equivalent nurses to meet ratio needs, wage increases for registered nurses, and operational costs for developing and implementing the ratios.

However, there could also be cost savings, the report pointed out. Hospitals could see potential savings of between $34 and $47 million because of reduced adverse patient safety incidents and reduced hospital length of stay because of higher quality care.

Additionally, HPC estimates decreased nurse turnover because the staffing ratios would limit nurse burnout.

The nurse job market would also open up, the report found. Organizations would need between 2,286 and 3,101 additional full-time equivalent nurses to keep up with patient needs and to adhere to the staffing ratios.

The number of nurses organizations would need to hire would vary depending on facility type. For example, community hospitals that treat a high proportion of MassHealth (the state’s public option) and Medicaid patients would need 21 to 30 percent more nurses.

Other community hospitals would need 14 to 20 percent more nurses and academic hospitals in Massachusetts would need between 5 and 7 percent more nurses. Additionally, HPC estimates all hospitals would need increased staffing (23 to 32 percent) for night shifts.

Different hospital departments would also need different numbers of newly hired nurses, the report revealed. Medical/surgical units would need 46 percent more nurses, while psychiatric nurses would need 18 percent more hires. Labor and delivery units would need 15 percent more nurses. HPC also predicts freestanding psychiatric units would need more nurses.

Most of HPC’s cost estimates are conservative, the Commission said. This is because it did not account for costs of RN services in emergency departments, outpatient departments, and observation units. These units did not have sufficient data for HPC to calculate estimates.

The estimates also did not include costs associated with non-acute hospitals, state agency implementation, turnover and recruitment, and penalties for non-compliance to the ratio mandates.

The results also may differ from similar studies investigating the costs of implementing nurse staffing ratios, said the HPC’s executive director David Seltz.

“The estimated costs are likely to be conservative as we were not able to include, due to data limitations, certain costs related to implementation in Massachusetts emergency departments, observation units, and outpatient departments,” Seltz explained in a statement. “Our approach to the cost impact estimate was developed independently from other studies and as a result, our findings differ from those in other public reports on this issue. We welcome any comments or feedback from the public and other interested stakeholders on this analysis in advance of the annual Cost Trends Hearing on October 17.”

The HPC report did not make any voting recommendations. However, the Commission will present these results at the annual Health Care Cost Trends Meeting on October 16 and 17. At this public meeting, key healthcare stakeholders throughout Massachusetts will discuss the report’s findings and the implications of a passage on the staffing ratios question.

“Consistent with this role, we conducted an independent analysis of the potential costs related to mandated nurse-to-patient staffing ratios,” said Stuart H. Altman, HPC Chair. “Our analysis raises significant questions about the impacts of these ratios on health care costs and spending in the Commonwealth. We look forward to more discussion about the implications of our analysis at the upcoming cost trends hearing.”