Contribution of Clinical Nurses to Hospital Efficiency and Economic Sustainability: A Systematic Review

Aim: To analyze the existing evidence on the contribution of the nursing profession to efficiency and healthcare sustainability in the hospital setting. Background: Promoting economic efficiency in hospital centers is a key factor in ensuring their long-term sustainability. In this regard, nursing professionals with caregiving roles could emerge as valuable contributors to the survival of the existing hospital model. Design: A systematic review was conducted following PRISMA guidelines. This review has been registered with PROSPERO under the registration number: CRD42023481140. Method: A search was conducted across four international databases (CINAHL, PubMed, Scopus, and WOS) from 2013 to the present for studies in English and Spanish. Primary studies on economic evaluations and systematic reviews were included. The study selection was carried out in three stages, with two reviewers independently analyzing the data and resolving disagreements through discussion and consensus. The quality assessment utilized the CASP tool, the CHEERS checklist, and the STROBE statement. Results: Out of 3058 records identified, nine were deemed eligible, comprising one longitudinal study, four descriptive studies, two systematic reviews, two randomized controlled trials, one cohort study, and two case-control studies, with a total of 333,597 patients. The studies varied in sample size, intervention strategy, content, measurement scales, and statistical analysis of the primary outcome. The studies indicate that health education provided by hospitals is cost-effective, potentially generating costs below 100,000 dollars per quality-adjusted life year. Investing in nursing specialty, advanced practice nurses, and clinical safety reduces the number of admissions and decompensations. Conclusions: This review highlights that health education and clinical safety are the areas where nursing tasks have the most significant economic impact. Nursing specialty and the inclusion of advanced practice nurses are proving to be fields towards which health systems should focus to promote a more economically sustainable model.