The relationship between nurse staffing and the quality and safety of care has been reported. This study compares three strategies of nurse staffing to determine their impact on costs, associated hospital days, adverse outcomes, and deaths. The options included raising the proportion of registered nurses (RNs) without changing total nursing hours, increasing nurse staffing, and a combination of both strategies. Although the change in proportion of RN staffing offered a cost savings, the latter option had the greatest effect on reduction of adverse outcomes and hospital days. However, the savings from these clinical improvements were not offset by the costs of staffing changes. The authors suggest that hospitals and patients likely share different perspectives on the value added by the nurse staffing options discussed, and health care payers may provide the financial incentive to address this gap.