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”
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.
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“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 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”
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.