Nursing cutbacks are directly linked to higher patient death rates in hospitals, a major study has found.
Every extra patient added to a nurse’s workload increases the risk of death within a month of surgery by 7%, according to data from 300 European hospitals in nine countries.
The situation is made worse by employing poorly qualified nurses, the research showed. But nurses had university degrees, it went a long way towards making up for reduced staffing levels.
A 10% increase in the proportion of nurses holding a bachelor degree was associated with 7% lower surgical death rates.
The findings, published in The Lancet journal, included figures for 30 English hospitals showing that on average every one of their nurses looked after around nine patients.
“Our findings emphasise the risk to patients that could emerge in response to nurse staffing cuts”
Professor Linda Aiken
In some other countries the patient-to-nurse ratio was significantly smaller. Norway had a ratio of 5.2 to one, the Irish Republic 6.9, the Netherlands seven and Finland and Sweden 7.6.
Spain appeared to have the most overworked staff, with an average 12.7 patients per nurse. But in Spain every nurse had a bachelor degree, compared with only 28% in England at the time the data was collected in 2009-10.
Since September last year, every newly qualified nurse in the UK has had to possess a university degree.
Professor Linda Aiken, from the University of Pennsylvania School of Nursing, who led the research, said: “Our findings emphasise the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelor’s education for nurses could reduce hospital deaths.”
The study analysed information on more than 420,000 patients admitted to hospitals in Belgium, England, Finland, the Irish Republic, the Netherlands, Norway, Spain, Sweden, and Switzerland.
Researchers compared nurse workload and education and patient outcomes, taking into account a number of factors that could influence the result.
These included the age and sex of patients, types of surgical procedure, chronic conditions, and the kind of technology available in a hospital.
The overall percentage of surgical patients who died within 30 days of admission was low, ranging between 1% and 1.5% per country. In England, the average rate was 1.4%.
However, in every country death rates varied significantly between individual hospitals, with some losing up to 7% of surgical patients after 30 days.
The highest risk of death after surgery was found in hospitals where nurses with lower levels of education cared for the most patients, said the researchers.
A comparison was made between hospitals where every nurse cared for an average of six patients and the proportion of degree-educated staff was at least 60%, and those where nurses looked after eight patients each and just 30% had bachelor degrees.
The hospitals with lighter workloads and more qualified nurses were expected to have 30% lower surgical death rates.
“Our data suggest that a safe level of hospital nursing staff might help to reduce surgical mortality, and challenge the widely held view that nurses’ experience is more important than their education,” Dr Aiken added.
The European findings closely mirrored similar trends seen in the US, said the researchers.
The findings follow a survey of 526 nurses by Nursing Times earlier this month, which found 57% believed their wards were “dangerously understaffed”.
Peter Carter, chief executive of the Royal College of Nursing (RCN), said: “It is worrying to see that researchers found the mean ratio of patients to nurses in England is above eight, as we know that this can compromise patient safety.”
Dr Peter Carter
The findings also supported the UK’s recent decision to make nursing an all-graduate profession, Dr Carter added.
“Compassion and caring will always be at the heart of nursing practice and nurse training,” he said. “However, the demands of modern health care mean that this must be backed up by a higher level of education so that patients, who often have complex needs, receive skilled and compassionate care..
“Modern medicine means that a nurse’s role is far more technical and requires complex decision making which demands a degree level education as well as the practical experience which currently makes up at least half of a nursing degree.”
In November, the government’s response to the inquiry into Stafford Hospital stopped short of introducing a minimum staff-patient ratio on wards or enshrining this in law.
Organisations, including the RCN, have called for a minimum of one nurse for every eight patients.
“This research comprehensively rebuts the myth that degree-level education for nurses is a retrograde step”
Professor Ieuan Ellis
Professor Ieuan Ellis, chair of the Council of Deans of Health, which represents all UK university faculties providing education and research for nursing and midwifery, also commented on the importance of the findings on degree nursing.
He said: “This research comprehensively rebuts the myth that degree-level education for nurses is a retrograde step.
“In fact, this study shows that education to bachelor’s level is a significant protective factor in reducing unnecessary hospital deaths.”
Study summary at a glance
Background: The RN4CAST study was designed to inform financial decision-making about nursing.
Method: Researchers obtained discharge data for 422,730 patient aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education.
Results: An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%, and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7%.
Conclusion: Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths.
Source: The Lancet
- Read the full paper in the Lancet: Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
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