This article examines the literature on cost-effectiveness in nursing, and considers the relationship between this literature and decision-making in health care systems. Researchers have attempted to examine costs and benefits of nurse staffing and nursing interventions for decades. There are strong literatures for some topics, such as advanced practice nursing, clinical practices, occupational health nursing, and workplace training. However, there are gaps in the literature on the cost-effectiveness of nurse staffing patterns, the use of agency personnel, and changes in organizational structure. A review of 6 major health care management textbooks finds few references to cost-effectiveness analysis, suggesting that health care leaders have little education regarding how to conduct or evaluate economic studies. The agenda for nursing research on cost-effectiveness is daunting. Research must be based on large, representative samples; provide clear, compelling results; discuss the importance of both costs and benefits in decision-making; and be published in highly-visible journals.
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- Public policy and nurse staffing.J Nurs Adm. 2005; (in press.)
- Patient safety—How much is enough?.Health Policy. 2005; 71: 223-232
- Economic evidence for evidence-based practice.J Nurs Scholarsh. 2002; 34: 277-282
- Conference on cost-effectiveness and patient care.Nurs Res Report. 1967; 2: 2
- Nursing—a cost-benefit analysis.R Soc Health J. 1976; 96: 208-211
- Cost-effectiveness analysis.Nurs Adm Q. 1978; 3: 17-40
- Applying cost-analysis techniques to nursing.Nurs Health Care. 1982; 3: 427-430
- Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996.Nurs Res. 1999; 48: 94-104
- Decision making the explicit evidence-based way.Nursing Prax N Z. 1999; 14: 33-42
- Does nursing need ’the dismal science’? The case for economic evaluations in nursing.Nurs Times Res. 1999; 4: 448-457
- Nurses’ attitudes towards cost-effectiveness and quality of care.Cost Qual Q J. 1998; 4: 18-22
- Cost-effectiveness analysis in the nursing literature, 1992-1996.J Nurs Scholarsh. 1998; 30: 235-242
- Economics of quality ulcer care.Dermatol Nurs. 2003; 15: 59-61
- Cost-effectiveness of wound management in France.J Wound Care. 2002; 11: 219-224
- Cost-effectiveness of treating deep diabetic foot ulcers with Promogran in four European countries.J Wound Care. 2002; 11: 70-74
- Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls.BMJ. 2001; 322: 701-704
- Cost-effectiveness issues for home I.V. therapy in the United States.Hosp Forum. 1993; 28: 37-40
- Cost effectiveness of home and community-based care.Health Care Financ Rev. 1989; 10: 65-78
- Specialist nurse management programmes.Pharmacoeconomics. 2003; 21: 225-240
- The 2-year costs and effects of a public health nursing case management intervention on mood-disordered single parents on social assistance.J Eval Clin Prac. 2002; 8: 45-59
- Reducing costs through case management.Nurs Manage. 1997; 28: 34-37
- A cost-effectiveness analysis of acute care case management outcomes.Nurs Econ. 1995; 13: 129-136
- Cost-effectiveness and quality of care provided by clinical nurse specialists.J Psychosoc Nurs Ment Health Serv. 1994; 32: 21-24
- Using cost-analysis techniques to measure the value of nurse practitioner care.Int Nurs Rev. 2002; 49: 243-249
- An evaluation of a nurse-led ear care service in primary care.B J Gen Pract. 1997; 47: 699-703
- A cost-effectiveness analysis of neonatal nurse practitioners.Nurs Econ. 1997; 15: 92-99
- Demonstration of the cost-effectiveness of a nurse practitioner/physician team in long-term care facilities.HMO Pract. 1994; 8: 157-161
- The cost-effectiveness of nurse practitioners.Nurs Practit. 1990; 15: 40-42
- Establishing cost-effectiveness in occupational health nursing.AAOHN J. 1987; 35: 449-453
- An economic analysis of the investment in nurse anesthesia education.AANA J. 1998; 66: 153-160
- Community outreach.J Nurs Adm. 1996; 26: 38-42
- Rural mobile health unit.Public Health Nurs. 1998; 15: 3-11
- A cost-benefit analysis of training nurses for extended roles.Nurs Times. 2003; 99: 34-37
- Measurement of return on investment of workplace education.J Nurses Staff Dev. 2000; 16: 157-163
- Cost and benefit of the trained laparoscopic team.Surg Endosc. 1997; 11: 812-814
- Do the benefits of continuing education outweigh the costs?.BJN. 1993; 2: 321-324
- Benefits and costs of continuing nursing education.J Contin Educ Nurs. 1991; 22: 104-108
- Comparing two methods of hospital orientation for cost effectiveness.J Nurses Staff Dev. 1987; 3: 3-8
- Nurse staffing patterns and hospital efficiency in the United States.Soc Sci Med. 1997; 44: 147-155
- All-RN model of nursing care delivery.Inquiry. 1983; 20: 173-184
- The effects of all-RN and RN-EN staffing on the quality and cost of patient care.Aust J Adv Nurs. 1993; 10: 27-39
- Cost-effectiveness of clustered unit vs. unclustered nurse floating.Nurs Econ. 1997; 15: 294-300
- Cost analysis of alternative scheduling.Nurs Managem. 1989; 20 (46-7): 42-43
- Cost-effectiveness of contractual nursing services.Nurs Econ. 1986; 4: 43-44
- The use of registry nurses in critical care.Dimens Crit Care Nurs. 1982; 1: 88-96
- Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.J Am Med Assoc. 2002; 288: 1987-1993
- Nurse staffing and patient perceptions of nursing care.J Nurs Adm. 2003; 33: 607-614
- Nurse staffing and postsurgical adverse events.Health Serv Res. 2002; 37: 611-629
- Nurse patient ratios.J Nurs Admin. 2004; 34: 326-337
- Nurse-staffing levels and the quality of care in hospitals.N Engl J Med. 2002; 346: 1715-1722
- The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.Nurs Res. 2003; 52: 71-79
- ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy.Intensive Care Med. 2000; 26: 1857-1862
- Health services research in nursing.Nurs Econ. 1990; 8: 229-238
- Challenges for nursing research in an era dominated by health service reform and cost containment.Clin Nurs Res. 1993; 2: 382-395
- Gold M.R. Siegel J.E. Russell L.B. Weinstein M.C. Cost-Effectiveness in Health and Medicine. Oxford University Press, New York, NY1996
- Evaluation of studies of health economics.Evid Based Nurs. 2002; 5: 100-104
- Achieve cost benefits with innovative care management.Nurs Managem. 2002; 33: 35-42
- RNs may cost less than you think.J Nurs Adm. 1986; 16: 28-34
- The economic value of nursing.Nurs Econ. 1992; 10: 193-204
- Increased unintended patient harm in nursing practice as a consequence of the dominance of economic discourses.Int J Nurs Studies. 2004; 41: 293-298
- Partnership economics.Nurs Econ. 1999; 17: 299-307
- Blackwell Publishers, 2002 Strategic Management of Health Care Organizations. 4th ed.
- Health Care Management. Delmar Publishers, 1989
- Delmar Learning, 2002 Financial Management in Health Care Organizations. 2 ed.
- Delmar Learning, 1996 Essentials of Health Care Management. 1 ed.
- Jones & Bartlett Publishers, 1997 Risk Management in Health Care Institutions A Strategic Approach. 1 ed.
- Jossey-Bass Inc, 1990 Innovations in Health Care Delivery Insights for Organization Theory. 1 ed.
Dr. Joanne Spetz is an Associate Professor at the University of California, San Francisco, CA.
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.