As the complexity of hospitalization patients grows, nurse practitioners (NPs) in advance care roles are a valuable adjunct to the existing labor resources (physician and nurses), according to study findings published in Medical Care. Hospitals that employ more inpatient NPs showed improved patient outcomes, greater staff nurse satisfaction, and lower surgical mortality and cost of care.

It is well known that better hospital staffing is associated with positive inpatient outcomes, including fewer readmissions and higher patient satisfaction. “Hospitals that employ more NPs per 100 beds have lower mortality, higher patient satisfaction, and lower health care spending per episode of care even after taking into account other investments in RN staffing,” said lead study author Linda H. Aiken, PhD, FAAN, FRCN, professor of nursing and sociology and founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. “Nurse practitioners are very valuable in inpatient hospital settings as they are associated with improved clinical outcomes, better wellbeing of direct care RNs, and positive financial outcomes.”

The study aimed to determine whether an increase in NPs produced better outcomes in inpatient care. The researchers examined data collected from 2015 to 2016 from more than 1.4 million patients in 579 hospitals. A number of surveys were used to collect the data for the study such as RN4CAST-US nurse surveys, Hospital Consumer Assessment of Healthcare Providers and Systems patient surveys. Data from surgical patient discharge abstracts, Medicare Spending per Beneficiary reports, and the American Hospital Association annual survey were also included.

Continue Reading

The study’s objective was to determine “for the first time in a nationally representative sample of hospitals and patients whether increased NP staffing in hospitals adds value after taking into account investments hospitals have already made in RN staffing and preferential hiring of RNs with bachelor’s education,” said the study authors. Hospitals were grouped based on their NP to bed ratios (<1 NP/100 beds, n=132; 1–2.99 NPs/100 beds, n=279; 3+ NPs/100 beds, n=168). 

Patients in hospitals with 3 or more NPs per 100 beds had lower mortality rates, fewer readmissions, and shorter length of stay than patients in hospitals with less than 1 NP per 100 beds. Both patients and nurses in hospitals with higher NP to bed ratios reported better quality of care and safety. Nurses also reported lower burnout rates, higher job satisfaction, and greater intentions of staying in their jobs.

“This is the first large study to document the significant added value of hospitals employing NPs in acute inpatient hospital care as well as having good RN staffing,” said Dr Aiken. “When we compared hospitals with the most and fewest NPs, we estimated that hospitals with more NPs had 21% fewer deaths after common surgical procedures and 5% lower Medicare costs per beneficiary.”

An increased number of NPs in advanced care roles in inpatient care are linked to positive outcomes in patient care and nurse staffing, study authors concluded. The findings “are relevant to policy debates taking place in many states regarding modernizing state practice acts governing NP scope of practice,” they added.


1. Aiken L, Sloane D, Brom, H, et al. Value of nurse practitioner inpatient hospital staffing. Medical Care. 2021;59(10):857-863 doi:10.1097/MLR.0000000000001628

2. Penn Nursing. Hospitals with more inpatient nurse practitioners linked to better outcomes, more satisfied patients. News release. Accessed January 31, 2022.