NIH News Release
National Institute of Nursing Research

Tuesday, October 22, 2002
4:00 p.m. ET

Linda Cook
National Institute of Nursing
(301) 496-0209

Joy McIntyre
University of Pennsylvania
School of Nursing

More Surgical Patients Die When Nurses' Caseloads Increase

A study of 168 hospitals in Pennsylvania has found that for each additional patient over four in a registered nurse's workload, the risk of the death increases by 7% for surgical patients. Patients in hospitals with the lowest nurse staffing levels (eight patients per nurse) have a 31% greater risk of dying than those in hospitals with four patients per nurse. On a national scale, staffing differences of this magnitude could result in as many as 20,000 unnecessary deaths annually. The findings are contained in the article "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction," and appear in the October 23-30 issue of JAMA. The research was funded by the National Institute of Nursing Research (NINR), NIH, part of the U.S. Department of Health and Human Services.

Another finding relating to the national hospital nurse shortage indicates that each additional patient per nurse is related to a 23% increased risk of nurse burnout and a 15% increased risk of job dissatisfaction. Of nurses with high burnout and dissatisfaction, 43% intend to leave their jobs within the next year, compared to only 11% who plan to leave and do not have burnout and dissatisfaction. This finding has a direct bearing on increasing hospital costs. Estimates published elsewhere indicate that the cost of replacing a hospital specialty nurse can amount to $64,000. Thus satisfactory nurse staffing levels can save money, as well as lives, and help retain staff.

According to principal investigator Linda Aiken , PhD, RN, "Clearly, there is a direct relationship between nurse staffing and patient well being. Nurse staffing is an issue that needs priority attention on a national scale. Patients' lives depend on it." Dr. Aiken is the Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

"This research underscores the nurse's importance as a key member of the healthcare team," said Dr. Patricia A. Grady, Director of the NINR. "The effectiveness of nursing care depends on close proximity and observation of patients, astute interactions, and effective, timely action when problems occur. Policymakers, administrators, and healthcare professionals of all disciplines must work together to ensure that high quality care is the norm in our country. Unnecessary deaths of patients must be prevented."

The study data — from 1998 and 1999 in Pennsylvania — included 10,000 nurses and over 232,000 surgical patients with common surgeries, such as appendectomies, and orthopedic and vascular surgeries.

More information about nursing research is available at the NINR website at