title: Economic evaluation of registered nurse tenure on nursing home resident outcomes.
abstract: OBJECTIVE
  Little is known about the economic implications of nursing home (NH) registered nurse (RN) tenure on resident outcomes. This study evaluated the cost-effectiveness of two nurse workforce scenarios focusing on RN tenure (high versus low), and the associated transfers from NH to the hospital.
  
  
  METHODS
  A decision tree was constructed to compare the incremental costs and effects of RN tenure scenarios on NH resident transfers to the hospital under two NH staffing scenarios: high versus low levels of RN tenure. Three outcomes were modeled: 1) dollars per hospitalization avoided, 2) dollars per hospitalization and death avoided, and 3) dollars per death avoided.
  
  
  RESULTS
  The total costs of care for the low tenure scenario were $34,108 per month compared to the high tenure scenario at $29,442 per month. Effectiveness of the high tenure was greater across all 3 outcomes (incremental effectiveness ranged from 0.925 to 0.974 depending on outcome), indicating that high tenure was the dominant strategy (that is less costly and more effective).
  
  
  CONCLUSIONS
  Higher RN tenure was a dominant strategy across the 3 outcomes. This was a fairly robust finding despite the variations in the model and uncertainty in the input parameters. Aligning quality outcomes with cost effectiveness is imperative to driving the direction of health policy in the United States. Better prevention of hospitalizations by having an experienced RN workforce will not only improve resident quality of care but will allow NHs to realize the value of retaining a skilled workforce.
authors: Columbia University School of Nursing, Center for Health Policy at Columbia University Medical Center, New York City, 10032, USA.
authors: Mayuko
authors: M
authors: Uchida-Nakakoji
authors: Columbia University School of Nursing, Center for Health Policy at Columbia University Medical Center, New York City, 10032, USA. Electronic address: ps2024@columbia.edu.
authors: Patricia W
authors: PW
authors: Stone
authors: VA Heath Economics Resource Center, Palo Alto, 94305, USA.
authors: Susan
authors: S
authors: Schmitt
authors: VA Heath Economics Resource Center, Palo Alto, 94305, USA; Stanford University, Stanford, 94305, USA.
authors: Ciaran
authors: C
authors: Phibbs
authors: Mailman School of Public Health at Columbia University Medical Center, New York City, 10032, USA.
authors: Y Claire
authors: YC
authors: Wang
mesh_terms: D003362:Cost-Benefit Analysis; D009726:Nurses / Q000191:economics*; D009735:Nursing Homes / Q000191:economics*; D014481:United States
keywords: Cost-effectiveness analysis; Economic evaluation; Long-term care; Nursing; Veterans; Workforce