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Global nursing expert questions NHS policy on profession

  • 19 Comments

One of the world’s leading experts on nursing and safe staffing has questioned current NHS policies towards nurses and suggested some could even put patients at greater risk.

Professor Linda Aiken, director of the Centre for Health Outcomes and Policy Research at the University of Pennsylvania, said evidence on safe nurse staffing ratios was clear and showed ratios do work.

“Nurses are the experts on care and there has to be enough of them”

Linda Aiken

She said current NHS plans to create a new nursing assistant role at band 4 was “crazy”, because evidence in the US showed it actually increased mortality and poorer outcomes.

“The more non-nurses you have in a hospital setting the worse the outcomes are, especially if you substitute them for nurses,” she said in an interview with Nursing Times’ sister title Health Service Journal.

“In America, they are called licensed practical nurses and we are getting rid of them because the research shows the more of them we have the worse the outcomes, and they don’t save you any money,” she said. “We should learn from each other – there is no reason for the UK to go down that route.”

Professor Linda Aiken

Professor Linda Aiken

Professor Aiken, who was speaking during a visit to the Florence Nightingale Faculty of Nursing and Midwifery at Kings College London, has published more than 300 research papers.

Her work includes a paper published in The Lancet in 2014, which showed that, for every extra patient added to a nurse’s workload, the risk of death within a month was increased by 7%.

The paper, based on data from 300 European hospitals in nine countries, also showed a 10% increase in the proportion of degree-educated nurses was associated with 7% lower death rate.

Professor Aiken noted that there was “no lack” of quality nurses in the NHS system, but said “there is not a recognition of how important nursing is to get the outcomes you want”.

She urged nurses to use the data on nursing ratios and safe staffing and “push back” against policymakers with the evidence.

“I am not saying that staffing ratios are the be all and end all, but we have studied them and they do improve staffing, patient outcomes and reduce the nursing shortage and turnover of nursing. They do work,” she said.

Her comments contrast with current nursing workforce policy in the NHS, which has seen work on nurse safe staffing by the National Institute for Health and Care Excellence halted and a move towards a more multidisciplinary approach under NHS England.

“Nurse staffing is the necessary ingredient in quality and safety”

Linda Aiken

Professor Aiken said she was “totally opposed to the idea of teams as a policy concept”. “Teams have no place in policy, and the reason I say that is because as soon as you say ‘team’, nurses become invisible,” she said. “Nurses are the experts on care and there has to be enough of them.”

She added that a research paper would be coming out soon on skill mix, which would show that nursing was the “driving force behind patient outcomes and nursing workforce”.

“As soon as you start trying to substitute anybody else for a nurse, mortality goes up, infections go up, readmission goes up and all of the bad performance measures go up. This is the evidence,” she said.

“Nursing is a building block for quality and safety and if you don’t have that you can have all types of things but they are not going to make a difference,” she said. “Nurse staffing is the necessary ingredient in quality and safety.”

NHS England was approached for comment but said it did not wish to respond.

  • 19 Comments

Readers' comments (19)

  • This intervention is well timed as the government and NHSE are seeking ways through 'assistants to reduce costs as a mistaken way to increase 'efficiency'. Francis sent shock waves through trusts which are increasing nurse presence including the use of agency staff and costs are reflected in this 'retrenchment'. The profession needs to be proactive in this issue.

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  • At last some one making sence . Don't suppose for one minute any one will listene.

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  • Interesting.

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  • "NHS England was approached for comment but said it did not wish to respond."

    Says it all, really, doesn't it?

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  • michael stone

    Well:

    '“As soon as you start trying to substitute anybody else for a nurse, mortality goes up, infections go up, readmission goes up and all of the bad performance measures go up. This is the evidence,” she said.'

    seems intuitively correct. IF the idea is to replace nurses, by 'more skilled HCAs', then that seems dubious. But IF the idea is to upskill 'top-end' HCAs, so that they can more competently perform certain relatively simple tasks and thereby allow nurses to do more complex things, and HCAs can perhaps more-readily progress into qualified-nurse status, that isn't intuitively 'a bad idea'. It looks, like a good idea.

    As for 'Teams have no place in policy' I'm afraid that the idea of 'everyone trying to be part of the same team' is absolutely fundamental to my issues around end-of-life care, and my differences with policy hinge on 'whether family carers are a full part of the patient support team'. The idea that end-of-life can work properly, especially for patients who are in their own homes, WITHOUT a 'team concept' is simply crackers.

    But, if Professor Aitken is arguing that 'nurses become invisible' in hospital MDTs, presumably because to some extent the medics seem to 'take those over', that is a different issue.

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  • Stone. We don't need your 'intuitively correct.' We rely on valid evidence. Now run away and play yourself somewhere else.

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  • Michael Stone always seems to be able to nut things out rationally, unlike Linda Aiken

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  • michael stone

    Anonymous | 31-Oct-2015 8:26 pm

    Nonsense !

    You state:

    'We rely on valid evidence.'

    This is simply untrue, for much of healthcare and related behaviour.

    My degrees are in chemistry, and chemistry does have 'valid evidence' - we can chuck stuff into a test tube, and see what happens, because 'it is a simple system'.

    Healthcare is like that at one end - 'does an antibiotic kill a bug on a plate ?' for example, but it becomes increasingly questionable whether there is [and, in fact, even could be] 'genuinely valid evidence' for many of the things which involve either much more complexity, or a significant degree of human interaction, or both.

    Any analysis of 'safe staffing levels' falls into this 'so complex the results with not be unambiguous' category.

    As an example, I feel sure that before the WV expose, we would have been told that 'we have evidence about the level of bad practice in care homes - we do collect the figures' but after WV I think the instances of reported bad care/abuse increased by something like ten times: so, the previous 'evidence' was presumably wrong, or the people reporting had become 'more sensitized to bad behaviour', or the regulators were 'counting more things as bad behaviour'. Or, more to the point, some very-difficult-to-untangle mixture of all three (plus, anything else, which might muddy the waters).

    I have an idea that for decades, the standard treatment of serious burns, was based on a limited number of US sailors who were badly burnt during WW2 (less than 10 patients, is the figure which is in my mind, but I'm not certain). That was changed to new advice, I believe, some years ago - but any clinician using the old treatment, would have doubtless said 'there is evidence for this'.

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  • michael stone

    Correction to above:

    Any analysis of 'safe staffing levels' falls into this 'so complex the results will not be unambiguous' category.

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  • michael stone | 1-Nov-2015 12:26 pm

    Don't forget to clear up before you go and take your toys with you!

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