Beyond paychecks: Unravelling the nexus of nurse and physician wages and mortality in acute care settings - A cross-sectional study using routine data.

Background
In Switzerland, over half of hospital expenses go towards staff wages, where nurses and physicians form the biggest occupational groups. Wages within the same profession and experience level can vary, impacting job satisfaction, job seeking, turnover, and staff retention. The effects of such issues can negatively impact patient safety outcomes, for example higher mortality rates, and produce additional costs. Given the large magnitude wages play in hospital operating budgets, understanding their influence on patient safety is crucial, yet this topic has been insufficiently explored.
Objective
To investigate the association between nurse and physician wages and 30-day mortality as a patient safety indicator in acute care hospitals.Methods
In this cross-sectional study we used Swiss patient and hospital routine data from the year 2019, which we linked by matching the anonymised hospital identification number. For the descriptive analysis, frequencies and percentages were presented for categorical variables, along with central tendency and dispersion measures for numerical variables. A Generalised Additive Mixed Model was used to explore the association between nurse and physician wages aggregated at the hospital level, and all-cause 30-day mortality. Sensitivity analyses were conducted by applying the same procedures to the data from 2018 and 2020.
Results
Our sample consisted of 1,015,995 adult patient admissions and 94,364 employees (69,112 nurses, 25,252 physicians) within 82 acute care hospitals. Patients 30-day mortality in the year 2019 was 2.3 %. An association was identified between physician wages and 30-day mortality, indicating that higher wages reduced the likelihood of mortality by 2 % (OR 0.98 [95 % CI 0.96-0.99], p = 0.001). However, no such association was found between nurse wages and 30-day mortality (OR 1.00 [95 % CI 0.95-1.04], p = 0.900) length.
Conclusion
We believe that there is an underlying mechanism between wages and patient safety indicators of interrelated factors, such as job satisfaction and staffing levels, and propose this interrelation to be further investigated. Future results could lead to a more reasonable and efficient utilisation of hospital resources and improve patient safety as the ultimate goal.