The effects of All-RN and RN-EN staffing on the quality and cost of patient care.

This paper presents empirical evidence from a study that compared the quality and costs of patient care provided by two staffing regimes in an acute medical and an acute surgical ward in one hospital. As assessed by patient outcomes, there were few significant differences in either ward in the quality of care provided by all registered nursing staff and staff that was comprised of 80% registered nurses and 20% enrolled nurses. In the acute medical ward the all-registered nursing staff was more expensive per day and per hour for patient care adjusted for patient dependency; in the acute surgical ward the registered-enrolled nurse staff mix was more costly. The study found that nurses in both wards were confronted by continuously high workloads. Registered nurses reported that working with enrolled nurses (who were inexperienced in acute medical and surgical nursing) exacerbated their workload and, to a lesser extent, made their work more stressful. Large scale, long term studies are necessary to clarify the issues of cost effectiveness of RN-EN mix and workloads.