Replacing registered nurses in high stakes hospital care is dangerous to patients

A new Penn Nursing study shows that substituting registered nurses with lower-wage staff in hospital care is linked with more deaths, readmissions, longer hospital stays, poorer patient satisfaction, and higher costs of care.

A new study highlights the effects of substituting registered nurses (RN) with lower-wage staff (e.g. licensed practical nurses, unlicensed assistive personnel) in hospital care. The study, by the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing (Penn Nursing), comes at a time when hospitals are struggling to recruit and retain RNs in hospital care because of poor working conditions. “Nurses in hospitals provide care for the sickest patients. It’s high stakes care. The findings show that replacing RNs with non-RN staff is dangerous to patients,” says lead-author, Karen Lasater, associate professor and the Jessie M. Scott Term Chair in Nursing and Health Policy.

nursing student taking blood pressure

Though hospitals often cite a low supply of RNs as the reason they cannot hire enough, the latest research shows there is no evidence of an RN shortage in the US. Thus, there is no justification for substituting less qualified staff for RNs.

The researchers studied the outcomes of over 6.5 million Medicare patients in 2,676 general acute care hospitals across the U.S. The researchers found that even a modest substitution in RN care is associated with poorer patient outcomes. Substituting RN care is associated with avoidable patient deaths, and alternative hospital staffing models yield a poor return on investment for hospitals. Additionally, Medicare risks spending millions of dollars annually on avoidable, preventable hospital readmissions.

“With roughly half of hospital RNs reporting high levels of burnout, hospitals should focus on fixing the root causes of their burnout—chronic understaffing and poor work environments—not replacing RNs with lesser trained nursing staff that the evidence shows is likely dangerous to patients,” says Lasater.

Read more at Penn Nursing News.