A new study led by researchers from Penn Nursing's Center for Health Outcomes and Policy Research (CHOPR) finds that safer nurse staffing levels in Pennsylvania hospitals could prevent thousands of deaths each year while improving care and providing savings that could finance better staffing.
The findings, published in Medical Care, provide timely evidence amid renewed interest in hospital minimum nurse staffing requirements in Pennsylvania. The state has seen momentum on nurse staffing legislation, most notably the Patient Safety Act, which was approved in a bipartisan vote in the House of Representatives in 2023 but was not called for a vote in the Senate before the session expired.
From recent data from Pennsylvania nurses and patients, the study analyzed outcomes for more than 547,000 patients and nearly 2,800 nurses across 132 hospitals statewide. The study directly addresses common concerns raised in policy debates, including workforce supply and potential impacts on rural hospitals.
Higher nurse workloads were consistently associated with worse patient outcomes. Each additional patient assigned to a nurse was associated with:
- 8% higher odds of patient death within 30 days
- 4% higher odds of hospital readmission
- Significantly longer hospital stays
Higher workloads also had significant consequences for the Pennsylvania nursing workforce, including:
- 33% higher likelihood of nurses experiencing high burnout
- 43% higher likelihood of nurses being dissatisfied with their jobs
- 27% higher likelihood of nurses intending to leave their jobs
"These findings reflect what we have seen consistently over decades of research," said senior author Linda H. Aiken, PhD, RN, FAAN , Professor and CHOPR Founding Director. "This study builds on that evidence by using recent, Pennsylvania-specific data to inform decisions happening right now."
Hospitals in the study showed wide variation in staffing, from 3 to 9 patients per nurse, often exceeding what nurses report is safe (typically 4–5 patients).
"Concerns about nurse shortages or impacts on rural hospitals are often raised in staffing discussions," said lead author Jane Muir, PhD, RN , Assistant Professor in the Department of Family and Community Health and CHOPR Senior Fellow. "Our findings show that nurses working in hospitals with better staffing report less burnout and turnover, and that currently rural hospitals in Pennsylvania are not staffed less favorably than other hospitals."
The study projects that implementing safer staffing ratios could have major statewide benefits, including up to 3,040 hospital deaths prevented annually, more than 2,100 hospital readmissions avoided, and over 77,000 hospital days avoided as a result of shorter length of stay associated with improved nurse staffing.
The financial implications are substantial, with an estimated $66 million in savings from reduced nurse turnover and $239 million in savings from shorter hospital stays that could offset the cost of hiring additional nurses and result in savings for state-funded hospital care.
"Ensuring safe nurse staffing is a proactive way to retain nurses and improve patient safety," Aiken added. "Policies like this can help prevent the kinds of workforce strain and disruptions that we've seen in other states."
Hospitals in Pennsylvania vary widely in nurse staffing levels, and those differences have clear consequences for patients, nurses, and health system performance.
