Thursday, 27 November 2014

Is there an economic case for nursing?

Roger Watson, Editor-in-Chief

Interest in nurse staffing levels and whether or not nursing is money well spent is intense. Perhaps international economic recession has focused attention on this against a background of changing demographics leading to deteriorating dependency ratios, increasing illness and the ‘bottomless pit’ that healthcare has become—especially in the developed world—as ever more illness becomes treatable, people survive longer and some seek healthcare for reasons that, to many, seem trivial. A systematic review from Australia by Twigg et al. (2014) titled ‘Is there an economic case for investing in nursing care –what does the literature tell us?’ and published in JAN investigates the economic case by looking at the existing evidence.

As with so many systematic reviews and studies on the cost of nursing care, the outcome is ambiguous. This will be sad news for those who simply advocate spending more money on nurses to increase nursing care with the aim of improving patient outcomes. Again, in common with many reviews, the problems are methodological with disparate methods being applied and multiple outcomes being used. In the words of the authors: ‘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.’ Nevertheless, this rigorous review provides a valuable insight into the ‘state of the science’ of economic evaluation of nursing and should be a stimulus for further work with agreed outcomes and methods whereby the issue can be investigated consistently.


Twigg DE, Myers H, Duffield C, Gies M, Evans G (2014) Is there an economic case for investing in nursing care – what does the literature tell us? Journal of Advanced Nursing doi: 10.1111/jan.12577

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