Date of Award


Degree Name

Doctor of Nursing Science


cost analysis, Meta-analysis, nursing


This descriptive meta-analytic study investigated 73 primary studies on costing out nursing services. A critical review of the literature revealed that findings from the various published and unpublished studies were inconsistent and inconclusive. This meta-analysis integrated the literature to identify the relationships between nursing costs and a second variable. The most frequently reported variables among the primary studies were compared using Pearson r correlations and percentages. The variables of total and direct nursing costs were correlated to the variables of length of stay, direct nursing care hours, hospital costs, and diagnostic related grouping (DRG) reimbursements. Analysis was conducted two ways. First the studies were treated as a single value for each variable reported. In addition, relationships were examined between the variables for frequently reported DRGs. Treating each study as a single finding, the research revealed statistically significant correlations between several variables. Total nursing costs were found to correlate.85 to direct nursing care hours,.99 to hospital costs, and.65 to length of stay. Direct nursing costs revealed.94 correlations to direct hours,.95 to hospital costs, and.83 to length of stay. Nursing costs did not correlate, with any statistical significance, to DRG reimbursements. When frequently studied DRGs were examined, only eight yielded statistically significant results, although no consistency between the variables was noted. When percentages were calculated, total nursing costs were reported to be 22.15% of hospital costs and direct nursing costs were found to be 15.68%. The major benefit nursing derives from costing out services is the increased ability to justify, monitor, and control costs within the cost-conscious health care environment. The use of meta-analysis, with descriptive primary studies, is validated as a tool for summarizing nursing knowledge and advancing nursing practice. A major limitation of this study was the different definitions of direct nursing care and direct nursing costs found among the primary studies. For future nursing research, specific definitions for total and direct nursing costs and direct nursing care are recommended.

Document Type

Dissertation: Open Access



Included in

Nursing Commons