Hospitals, like people, have credit scores. These scores—issued by agencies like Fitch, Moody’s, and S&P Global—tell lenders how financially trustworthy a hospital is. A higher score means the hospital can borrow money more easily and at better rates. This helps them fund big projects like new buildings, high-tech equipment, and expanded services.
But here’s where it affects you, the patient:
To maintain or improve these credit ratings, hospitals often need to show strong financial performance. One of the fastest ways hospitals cut costs is to reduce staffing—especially nurses, meaning less workers to care for patients.
That’s where the problem starts.
Reducing the number of nurses per patient may help the hospital’s bottom line in the short term, but research shows it puts patient safety at risk. Lower nurse-to-patient ratios are directly linked to better health outcomes—fewer complications, lower mortality, shorter hospital stays—and even long-term cost savings for hospitals. In other words, safe staffing isn’t just better care, it’s smart financial strategy.
Still, hospitals under pressure from credit rating agencies may ignore that evidence. As one nurse at Abbott Northwestern put it, “We are living through what we believe to be a result of Allina’s efforts to please credit rating agencies… but this has come at the expense of workers.” Nurses describe being stretched too thin, often skipping breaks and working 12-hour shifts without enough support.
At St. Luke’s in 2022, management even said that agreeing to fair pay for nurses could hurt their credit rating and raise borrowing costs—so they pushed back on wage proposals, prioritizing their financial image over frontline staffing.
The bottom line
Hospitals are making financial decisions based on what credit rating agencies want to see. But when that means cutting nurse staffing or stalling investments in patient care, it can come at a real cost—to safety, quality, and your health.