Missed care is the reason why hospitals with lower registered nursing staff levels have a higher risk of patient death, new research published in full today has shown, sparking calls for more to be done to improve staffing levels.
Those behind the research said care left undone due to lack of time was the “missing link” in understanding variation in mortality rates in hospitals, as reported earlier this year by Nursing Times when the interim findings were revealed.
For every 10% increase in the amount of care left undone, there was a 16% increase in the likelihood of a patient dying following common surgery, according to the study, now published in the International Journal of Nursing Studies.
“If there are not enough registered nurses on hospital wards, necessary care is left undone, and people’s lives are put at risk”
Incomplete nursing care included activities such as patient surveillance, administering medicine on time, adequate documentation, comforting patients and pain management.
The findings give the “clearest indication yet” that there may be a “causal” relationship between registered nurse staffing levels and patient mortality, according to the the authors of the paper, called Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study.
The research has sparked calls from the Royal College of Nursing for the government to increase its efforts to ensure there are enough nurses trained and that staff are not forced to leave the profession due to burnout.
“[This study] is more evidence that shows that you cannot substitute fully qualified registered nurses with less qualified staff”
The new findings come from further analysis of the RN4CAST study of nurse staffing at hospitals in nine European countries, including 31 NHS acute trusts in England, from 2010.
Previous analysis of the major study showed that lower nurse staffing levels were associated with higher patient mortality rates, but did not reveal the “missing link” between the two.
- Nurse cuts ‘linked to death rates’, says major study
- Diluting nursing skill mix linked to higher patient mortality risk
- Nurse staffing levels linked to weekend death rates from stroke
“For years, we have known that there is a relationship between nurse staffing levels and hospital variation in mortality rates, but we have not had a good explanation as to how or why,” said lead study author Dr Jane Ball, principal research fellow at the University of Southampton.
“These results give the clearest indication yet that registered nurse staffing levels are not just associated with patient mortality, but that the relationship may be causal,” she said.
“If there are not enough registered nurses on hospital wards, necessary care is left undone, and people’s lives are put at risk,” added Dr Ball.
The analysis also looked at nurse qualifications and confirmed that hospitals with higher numbers of registered nurses trained to degree level had a lower risk of patient mortality.
“This research puts beyond doubt that patients pay the very highest price when the government permits nursing on the cheap”
Professor Peter Griffiths, chair of health services research at Southampton University, added: “This study reinforces the importance of registered nurses who are trained to a degree level.
“It is more evidence that shows that you cannot substitute fully qualified registered nurses with less qualified staff, without taking a risk with patient safety. It is the number of registered nurses on duty that is key to ensuring complete care and minimising the risk of patients dying,” he said.
Commenting on the findings, RCN chief executive and general secretary Janet Davies, said:“Despite years of warnings, hospitals across the country do not have enough nurses. This research puts beyond doubt that patients pay the very highest price when the government permits nursing on the cheap.”
”As the nurse shortage bites, hospitals are filling wards with unregistered healthcare assistants in a bid to cope, especially at night. Ministers cannot ignore further evidence that the lack of registered nurses leads to people left in pain for longer and a higher risk of not recovering at all,” she said.
“Pressure in the NHS is mounting, nurses are pulled in every direction and important things are inevitably missed,” added Ms Davies.
“The government must redouble its efforts to train and recruit more nurses and stop haemorrhaging experienced professionals who feel burnt out and undervalued,” she said, calling on ministers to remove the public sector pay cap in the forthcoming budget to help tackle staffing problems.