title: Is there an economic case for investing in nursing care--what does the literature tell us?
abstract: OBJECTIVE
  To determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients?
  
  
  BACKGROUND
  Research has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions.
  
  
  METHODS
  A systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence.
  
  
  METHODS
  The MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits.
  
  
  METHODS
  The review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes.
  
  
  RESULTS
  Four-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results.
  
  
  CONCLUSIONS
  This review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies.
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Twigg
authors.forename: Helen
authors.initials: H
authors.lastname: Myers
authors.forename: Christine
authors.initials: C
authors.lastname: Duffield
authors.forename: Margaret
authors.initials: M
authors.lastname: Giles
authors.forename: Gemma
authors.initials: G
authors.lastname: Evans
mesh_terms: D002983:Clinical Competence; D004471:Economics, Nursing; D009732:Nursing Care; D010561:Personnel Staffing and Scheduling
keywords: acute care; economic evaluation; literature review; nurse sensitive outcomes; nurse skill mix; nurse staffing; nursing; patient outcomes