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reduce healthcare costs by as much as 30 percent. Increased staf���ng reduces the likelihood of post-discharge adverse events, making it possible for the hospital to break even on the additional investment in nursing. ��� (2008) ���Overcrowding and understaffing in modern health-care systems: key determinants in penicillin-resistant staphylococcus aurous transmission.��� Lancet Infectious Disease Understaffing of nurses is a key factor in the spread of methicillin-resistant staph infection (MRSA). ��� (2008) ���Patient Safety and Quality: An Evidence-Based Handbook for Nurses��� United States Department of Health and Human Services, AHRQ Publication No. 08-0043 Improved RN staffing ratios are associated with a reduction in hospital-related mortality, failure to rescue, and lengths of stay. ��� (2008) ���Patient Safety and Quality: An Evidence-Based Handbook for Nurses��� United States Department of Health and Human Services, AHRQ Publication No. 08-0043 Every additional patient above four assigned to an RN is associated with a 7 percent increase in the risk of hospital-acquired pneumonia, a 53 percent increase in respiratory failure, and a 17 percent increase in medical complications. ��� (2007) ���Nurse staffing level and nosocomial infections: Empirical evaluation of the case-crossover and case-time-control designs.��� American Journal of Epidemiology When the number of patients per RN per shift in the ICU decreased from 3.3 to less than 1.6, there was an associated 43 percent odds reduction of nosocomial sepsis. Analysis showed a 30 percent reduction in odds for nosocomial pneumonia with higher RN staffing in the ICU. ��� (2007) ���Hospital workload and adverse events.��� Medical Care A 0.1 percent increase in the number of patients assigned per nurse led to a 28 percent increase in the adverse event rate. Hospital administrators should allow nursing supervisors the leeway to institute policies that accommodate a larger on-call pool to ���flex up��� to a safe number of nurses. ��� (2007) ���Nurse working conditions and patient safety outcomes.��� Medical Care 20 N AT I O N A L N U R S E Patients cared for in hospitals with higher RN staffing levels were 68 percent less likely to acquire a preventable infection, according to a review of outcome data of 15,000 patients in 51 U.S. hospitals. ��� (2007) ���Staffing level: a determinant of late-onset ventilatorassociated pneumonia.��� Critical Care A higher number of assigned patients per RN is associated with increased risk for late-onset ventilator-associated pneumonia. VAP prolongs length of stay by up to 50 days, duration of mechanical ventilation by five to seven days, and generates substantial extra costs, in the order of $10,000 to $40,000 per episode. ��� (2006) ���Are patient falls and pressure ulcers sensitive to nurse staffing?��� Western Journal of Nursing Research Compared to patients whose nurse had three or fewer patients, the likelihood of falling was three times higher for patients whose nurse had four to six patients and was seven times higher when the nurse had seven or more patients. ��� (2006) ���Nurse staffing in hospitals: Is there a business case for quality?��� Health Affairs Increasing the hours and raising the proportion of nurses who are RNs would result in a $5.7 billion savings and save 6,700 lives and four million days of patient care in hospitals each year. ��� (2006) ���Charting Nursing���s Future: Balancing Nursing Costs and Quality of Care for Patients.��� RWJF Issue Briefs More registered nurses working on a hospital unit and reduction of RN overtime hours correlated with fewer readmissions, ER visits post-discharge, and reduced costs. ��� (2005) ���Improving nurse to patient staffing ratios as a costeffective safety intervention.��� Medical Care As a patient safety intervention, patient-to-nurse ratios of 4:1 are reasonably cost effective. ��� (2005) ���A case-control study of patient, medication, and carerelated risk factors for inpatient falls.��� Journal of General Internal Medicine Increasing the nurse-to-patient ratio is associated with a decreased risk of falling. W W W. N A T I O N A L N U R S E S U N I T E D . O R G NOVEMBER 2012