Longer Nurse Tenure on Hospital Units Leads to Higher Quality Care

When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is the largest study of its kind to link nurse staffing to patient outcomes. The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted the length of stay for patients. Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, a shorter length of stay indicates that the hospital provided better treatment. At the same time, a shorter length of stay also makes care more cost-effective. The study found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3 percent decrease in length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," says senior study author Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions - disrupting the balance of a team can make quality go down and costs go up."

While many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the study found that it's more cost-effective for hospitals to pay staff RNs overtime to work more hours on their unit. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies, the study found.

Nursing skill also mattered, the study found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

"This rigorous econometric analysis of nurse staffing shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units," says the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School.

The researchers used the VA's Personnel and Accounting Integrated Data for information on each nurse's age, education, prior experience, VA hire date, start date at the current VA facility, and start date for the current unit at that facility. To assess patient outcomes, the researchers used the VA's Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90 percent of all acute care stays in the VA system for the fiscal years 2003 to 2006.

> What do you think? Share your thoughts in the comments section below.


  1. Although I left the hospital setting years ago and I did complete my BSN since then, my many friends and co-workers who were fantastic and experienced were ‘let go’ because they didn’t have a BSN, the hospitals wanted only BSN level nurses which meant all new grads with little or no experience. This article shows why we had concerns…

  2. As the husband of Mrs. Woods, the previous commenter, I am extremely proud of Felacia and her years of hard work and dedicated joy in her profession. While it had been a thankless job for her quite often, she always kept focus on what it was all about: the patient and patient care! The best reward I could give her was a chance to come home if she really wanted to, as the nursing profession here in the south seemed to take more and give less, which is unfortunate for the patients sake. God bless those who carry the torch from here, and don’t ever forget why you’re there, aside from the paycheck.

  3. I’ll have to agree unanimously with this article. Not to discount the skill and intelligence that a new grad may bring to the the profession, but as a 17 year nurse on a recently started sabbatical I must agree. We offer not only skill but keener eyes and a sixth sense to the field that new grads and nurses that have only been in the craft for a few years are still learning. We are the veterans of the field, however, we are leaving in droves! Sad but true. Just weeks after leaving a PRN float position, I learn that my hospital has discontinued its pension plan. Don’t feel like I made a poor decision in regards to them but that is unfortunate; and this is the appreciation that is given for years of service? Some hospitals see longevity with their professionals and therefore shorter patient stays. KUDOS to those facilities! Unfortunately in the Southern Regions of the U.S. , turnover is a resounding theme. I have taken my expertise and pleasant bedside manner with me and brought them home to the hubby and kids. LICENSE still intact but not in service for this chapter of my life. It was a blessing to have the option to come home but to my comrades out there still making a difference emotionally and medically in the field; stay strong and keep up the fight. You are a key component to the outcome and success of any discharged patient. Keep it ?!


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