And when nurses had to work harder because of high patient turnover on their unit, the mortality risk increased by 4 percent.
"A telling outcome is that they looked at a hospital that really had pretty good staffing levels and they still found that there was a difference," said Sharon Wilkerson, dean of the Texas A&M Health Science Center College of Nursing in Bryan. "When I think about the number of hospitals that do not maintain good staffing levels, either because they can't find the nurses or maybe they're rural or they're just aren't as many people they can hire, that's even more frightening."
The authors believe the findings would apply at the very least to other similar hospitals.
"All hospitals need to have a system to identify what their target nurse staffing is, based on their patient needs, and this will vary from day to day," Needleman said.
Hospitals also need to find ways to manage surges, when more admissions and transfers send more patients to a particular unit, said Needleman, who believes these changes are possible.
"Obviously, we need to figure out how to do this better," Wilkerson said. "If the workloads and the turnover of patients are causing problems in terms of negative outcomes for patients, then we need to do a better job of handling that."
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SOURCES: Jack Needleman, Ph.D., professor, health services, UCLA School of Public Health, Los Angeles; Sharon Wilkerson, Ph.D., R.N., dean, Texas A&M Health Science Center College of Nursing, Bryan; March 17, 2011, New England Journal of Medicine
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