Patient‑level nursing cost analysis and cost drivers in acute care: A retrospective longitudinal study

BACKGROUND: In value-based care models, nursing expenses are often embedded within room charges, obscuring their specific contribution which challenges to assess nursing's financial value. PURPOSE: To estimate the patient-level nursing costs, determine the nursing cost share of room charge, and identify cost-related factors. METHODS: A retrospective, longitudinal study was conducted using linked patient and provider data. We decomposed nursing costs into 'labor demand' and 'labor price' using generalized linear models and mixed-effects models to distinguish patient-driven vs. structural cost drivers. DISCUSSION: The mean daily nursing cost was $586.23 per patient, accounting for 25.6% of the room charge. Patient acuity, Medicare Severity Diagnosis-Related Groups, nurse experience, and patient load were all significant predictors of nursing costs. CONCLUSION: This study presents a feasible method for estimating patient-level nursing costs using existing datasets. The findings confirm that nursing costs are directly related to patient needs, providing a data-driven approach to assess nursing's value.