Hospitals that offer nurses a better nursing environment and above-average staffing levels are associated with better value (lower mortality with similar costs), a study published online ahead of print in the journal JAMA Surgery has shown.1

The literature suggests that better nursing work environments lead to better quality of care for hospitalized patients; however, less is known about cost vs quality (value).

To determine the impact of nursing work environments on value and the patient risks associated with the greatest value, researchers conducted a retrospective matched-cohort design study comparing outcomes at focal hospitals and a control group of hospitals.

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Focal hospitals were those nationally recognized as having good nurse working environments and a nurse-to-bed ratio of 1 or greater. Control group hospitals did not have this recognition and a nurse-to-bed ratio of less than 1. 

The study included 25 752 elderly Medicare general surgery patients treated at 35 focal hospitals and 62 882 patients treated at 293 control hospitals in Illinois, New York, and Texas. Focal hospitals were larger and more teaching and technology intensive than the control hospitals.

The study was conducted January 1, 2004, to November 30, 2006; this analysis was conducted from April to August 2015. Thirty-day mortality was 4.8% vs 5.8% in focal hospitals vs control hospitals, respectively, with similar cost per patient. In addition, the greatest mortality benefit was observed in patients in the highest risk quintile (4.2% vs 5.8%). Cost difference was nonsignificant.

The study findings demonstrate that better nurse working environments and above-average staffing levels in hospitals are associated with better value compared with hospitals without nursing environment recognition and below-average staffing levels, especially for higher-risk patients.


1. Silber JH, Rosenbaum PR, McHugh MD, et al. Comparison of the value of nursing work environments in hospitals across different levels of patient risk [published online ahead of print January 20, 2016]. JAMA Surg. doi:10.1001/jamasurg.2015.4908.