Nursing care is so critical to patient safety that the Leapfrog Group will soon consider nursing hours per patient day when calculating Hospital Safety Grades. 

Beginning in fall 2023, the Leapfrog Hospital Survey will ask hospitals to report Total Nursing Care Hours per Patient Day and RN Hours per Patient Day. These measures will replace NQF Safe Practice 9: Nursing Workforce.

The Leapfrog Group’s decision to factor nursing care hours into Hospital Safety Grades was not met with universal applause. During the open comment period, “Several commenters expressed concerns about the timing of introducing Leapfrog’s Nurse Staff and Skill Mix measures … given the current staffing shortages,” according to Leapfrog’s Final Updates to the Leapfrog Hospital Safety Grade Methodology for Spring and Fall 2023. Other commenters asked that the new measures “not be added … since a national consensus and best measures regarding safety standards have yet to be reached.”

These arguments did not dissuade The Leapfrog Group. In fact, Leapfrog emphasized consumers’ rights to information about nurse staffing, stating that “We recognize that the widely reported nursing shortage can significantly impact hospital operation. However, that impact itself is why consumers and purchasers need insight about nurse staffing at each hospital. Nurse care is a core element to ensuring safe patient care in hospitals …”

The Link Between Nurse Staffing & Patient Safety

In the early 2000s, researchers began systematically studying (and quantifying) the impact of nursing care on patient outcomes. Consistently, they reported strong relationships between direct nursing care and positive patient outcomes. A classic 2005 study noted lower inpatient mortality rates for surgical patients who received care from more highly educated nurses. A 10% increase in the proportion of nurses holding a bachelor’s degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue, or patients suffering negative health consequences because nursing staff did not detect or intervene when patient health declined.  In 2010, the Institute of Medicine’s Future of Nursing Report called for 80% of the nursing workforce to earn a Bachelor of Nursing degree or higher by 2020. 

That goal was not met. According to the American Association of Colleges of Nursing, in 2020, 65.2% of the RN workforce earned a baccalaureate or higher degree.

Yet the link between nurse education, total nursing care hours, and improved patient outcomes stands. A 2012 study found that the odds of patients developing urinary tract infection (UTIs) during hospitalization decreased as total hours of nursing care per day (NHPPD) increased. When the RN proportion of the nursing workforce increases, the odds of UTI decrease even more. More NHPPD is also linked to decreased patient length of stay (LOS). UTIs and LOS both increase when NHPPD decreases.

“Because of the direct link between nursing workforce and safe care, Leapfrog believes the public deserves to know which hospitals have strong nursing workforces,” the organization said in 2014. At that time, Leapfrog assessed hospitals’ awareness of links between nurse staffing and patient safety and asked hospitals if they “conduct staff training and provide the budget needed to ensure adequate and competent nursing staff” and “implement policies and procedures to ensure adequate staffing.”  

Almost a decade later, Leapfrog has committed to asking hospitals to provide concrete numbers so consumers and payors know how much nursing time patients receive per day, on average, at specific hospitals. Total Nursing Care Hours per Patient Day and RN Hours per Patient Day are both listed on the National Database of Nursing Quality Indicators®.

Measuring NHPPD & RN Hours per Patient Day

Hospitals will soon need to report NHPPD and RN Hours per Day. Technology can make that job easier. The SwipeSense Nursing Insights application uses automated data capture to measure nursing time at the bedside without impacting clinical workflow or requiring extra effort. Because the system integrates with human resource systems, hospital leadership can also easily assess RN Hours per Patient Day.  

Healthcare organizations that hope to earn a top Hospital Safety Grade would do well to measure their baseline NHPPD and RN Hours per Patient Day now. Understanding your current skill mix and NHPPD may reveal some previously unacknowledged challenges and point to changes that will enhance patient care and outcomes.

Get in touch to learn more about how SwipeSense can help you prepare for the fall 2023 Leapfrog Hospital Survey.