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Objective: The aim of this study was to describe the methodology for nursing leaders to determine the cost of adverse events and effective levels of nurse staffing. Background: The growing transparency of quality and cost outcomes motivates healthcare leaders to optimize the effectiveness of nurse staffing. Most hospitals have robust cost accounting systems that provide actual patient-level direct costs. These systems allow an analysis of the cost consumed by patients during a hospital stay. By knowing the cost of complications, leaders have the ability to justify the cost of improved staffing when quality evidence shows that higher nurse staffing improves quality. Methods: An analysis was performed on financial and clinical data from hospital databases of 3,200 inpatients. The purpose was to establish a methodology to determine actual cost per case. Three diagnosis-related groups were the focus of the analysis. Five adverse events were analyzed along with the costs. Results: A regression analysis reported that the actual direct cost of an adverse event was $1,029 per case in the congestive heart failure cases and $903 in the surgical cases. There was a significant increase in the cost per case in medical patients with urinary tract infection and pressure ulcers and in surgical patients with urinary tract infection and pneumonia. The odds of pneumonia occurring in surgical patients decreased with additional registered nurse hours per patient day. Conclusion: Hospital cost accounting systems are useful in determining the cost of adverse events and can aid in decision making about nurse staffing. Adverse events add costs to patient care and should be measured at the unit level to adjust staffing to reduce adverse events and avoid costs. [ABSTRACT FROM AUTHOR]

We have enough evidence that burnout exists-let's investigate solutions., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

This era of health care reform calls for the ability of hospitals to provide quality patient care while managing costs. Nursing practice is a key determinant of patient care quality and associated costs, or simply put, creating value. The value of nursing has been addressed by multiple qualified authors, yet there is no clear, consistent meaning of the term. Researchers and authors have developed some theoretical foundation for the concept of value, which evolved into important research questions that establish value as an important outcome that is sensitive to nursing practice. The opportunity to attend 2 sessions at the Harvard Business School on health care value has prompted the need for nursing to adapt to common thinking on health care value and establish its meaning for the nursing profession. This report summarizes the nursing literature on value, reflects on the executive education, and proposes direction for nursing leaders in education and practice.

There is limited financial evidence describing the relationship between nursing staffing and patient care costs. In this analysis, the body of knowledge relating costs to nursing practice is described and critiqued. An improved method of describing costs of patient care is presented, and a comparison of costs using each approach illustrates how the magnitude of cost variation between 2 patients differs based on the approach used.

Patient care environments play a significant role in the nurses' ability to provide quality patient care and receive personal satisfaction through caregiving work. Hardiness is defined in terms of the presence of three characteristics: control, or the belief that individuals can control or influence occurrences in their lives; commitment, or an ability to feel involved in the activities of their lives; and challenge, or the anticipation of change as an exciting challenge to further development. These characteristics can be cultivated through the environment. Leadership actions and behaviors influence environmental development to stimulate and cultivate the characteristics of hardiness.