Associate Professor Lynn Unruh of the University of Central Florida says that having the proper number of registered nurses caring for patients may not cost more and in many cases has actually lowered the costs of providing care. Her research shows that it makes economic sense to properly staff. She says that more research needs to be done to establish nurse-to-patient ratio standards, but she feels that if the right balance is found, it will not only save lives, but save money as well.

Unruh said that quality and access to care in the U.S. health care system are below what is available in most other developed nations, but the costs are higher and that makes finding ways to improve care and reduce costs critical. She also said that because of the absence of national standards for nurse-to-patient ratios, the severity of patients' injuries must be considered when determining the appropriate staffing levels.

"What may be a proper ratio in one area may not be adequate in another," Unruh said. "We really need to develop those standards. But studies show that when the ratio is appropriate, the patient outcomes are better, nurses are more satisfied, and costs can be lower."

The review, published in this month's American Journal of Nursing (http://www.ajnonline.com), found that hospitals with higher RN staffing levels experienced lower rates of deaths, pneumonia, post-operative complications, and other negative patient outcomes. This means that patients were healthier and insurance companies didn't have to spend extra money for added procedures. And, in specialty units like geriatrics and obstetrics, there were fewer falls and medication errors, which protects hospitals from lawsuits and is good for patient well-being.

The review also found that nurses in better-staffed units were more satisfied and less likely to leave their jobs, saving hospitals the expenses of replacing them. It can cost as much as $160,000 to hire and train a new nurse.

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