Inadequate nurse staffing drives worse patient outcomes in for-profit hospitals

Patients treated at for-profit hospitals experienced higher mortality and readmission rates, while nurses working in those hospitals reported less safe staffing and substantially worse working conditions, according to a new study led by researchers at Penn Nursing's Center for Health Outcomes and Policy Research (CHOPR) and the Leonard Davis Institute of Health Economics.

The findings, published open access in Medical Care, arrive amid increasing hospital corporatization and profit-driven health care. The study found that differences in nurse staffing accounted for part of the observed lower quality in for-profit hospitals. The findings suggest that investments in nursing and state policies establishing safe staffing requirements are important and actionable mechanisms to ensure patient safety, nurse retention, and quality of care for patients regardless of the ownership type of their hospital.

Researchers studied the outcomes of more than 1.17 million patients across 143 for-profit and 798 nonprofit adult acute care hospitals in 10 states. Nurses in for-profit hospitals reported markedly worse staffing: 71% said their assigned patient workloads were not safe. Patient outcomes followed the same pattern. Compared with nonprofit hospitals, in for-profit hospitals:

• Patients experienced roughly 11 additional deaths per 1,000 medical admissions and 5 per 1,000 surgical admissions. Nurse staffing differences were a main explanation for higher mortality in for-profit hospitals.
• 30-day readmissions were 2.04 percentage points higher for medical patients and 1.76 percentage points higher for surgical patients (roughly 20 additional readmissions per 1,000 medical discharges and 18 per 1,000 surgical discharges), with staffing explaining 16% and 30% of the differences, respectively.
• Patients also rated for-profit hospitals lower, with worse nurse staffing accounting for lower overall hospital ratings.

The consequences for nurses working in for-profit hospitals were concerning. Nurse burnout was significantly higher in for-profit hospitals. Nurses in for-profit hospitals were far less likely to recommend their hospital to family and friends as a place of care or a place to work because of their concerns about poorer staffing.

"Treating safe nurse staffing as a core component of quality rather than a discretionary operating expense is especially important where incentives to cut labor costs are strongest," said lead author Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, Independence Chair for Nursing Education, Professor of Nursing, CHOPR Director at Penn Nursing, and Senior Fellow at the Leonard Davis Institute of Health Economics. "Minimum safe staffing requirements and ownership transparency are practical safeguards for patients and nurses."

The authors conclude that policies establishing minimum safe nurse staffing requirements and enhancing hospital ownership transparency could meaningfully improve patient, nurse, and hospital outcomes.