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Registered nurse levels affect patient mortality risk


Patient mortality rates are significantly affected by the number of registered nurses on a ward, a major US had shown.  

The research, published in the New England Journal of Medicine, adds to a growing body of evidence that qualified nurse staffing levels affect patient safety.

The results also chime with data analysis by Nursing Times two years ago, which showed the more nurses that a trust employs per bed the fewer of its patients are likely to die or experience long hospital stays (news, page 1, 31 March 2009)

The US researchers compared nursing shift data with the records of 198,000 patients in 43 wards at a large hospital. This included looking at the number of nurses on each eight hour shift.

They found patient mortality risk increased by 2% for each shift they were exposed to that was substantially understaffed. The average patient was exposed to three shifts that were understaffed, meaning their mortality risk was about 6% higher than for patients on wards that were always fully staffed.

Mortality risk was found to increase further still on wards where nurses’ workloads were increased by high patient turnover due to admission, discharges and transfers.

Responding to the study, American Nursing Association President Karen Daley said: “It shows that nurse staffing should not be viewed as a cost to be minimized, but as a critical factor in producing quality patient outcomes — ultimately saving lives.”

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Readers' comments (12)

  • This is not really new research is it??
    Those countries/States hospitals fortunate enough to have the 1:4 patient ratios have done all of the hard work before making it mandatory, and they looked at patient safety first!

    ANA add above
    " It shows that nurse staffing should NOT be viewed as a cost to be minimized , but as a CRITICAL factor in producing QUALITY patient outcomes- ULTIMATELY SAVING LIVES "

    I work with a 1:4/5 patient ratio, and it can still be hectic.
    One thing this does not mention is the increased acuity of patients at ward level which has impact.

    If the NT has already done data on this 2 years ago....what happened to that?

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  • Michael Sandiford

    This belongs in the "No sh*t sherlock" school of research.

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  • No surprises there then!! When the NHS has been pared down to the bones, and there aren't enough registered nurses left to care for the patients, the government will say,
    "why don't people want to train as a nurse any more?" Nothing to do with the pensions crisis or HCA's getting a cost of living pay rise when RN's don't of course!! Durr!!

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  • doesn't surprise me in the least. this isn't new research. i totally agree with Yvonne that it doesn't take into account of the increased acuity of patients. one day we can manage with 2 staff down but the next you may have admitted patients with a higher level of acuity and that is when you start to get an increase in patient/relative complaints, wandering confused patients can fall if there is noone to keep an eye on them and then you have the norovirus on the ward. the list is endless and why the ward needs to be fully staffed

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  • why does this need research and then the lengthy and costly process of analysing and publishing the results when it would be more logical, quicker and more effectively simply to take the professional advice of the nurses working on the wards as to the number of staff they need to do their job. is this is too simple for the complexities of modern management?

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  • What do you mean 2 years ago this was evident on research, I remember reading these articles 6-7 years ago if not longer and still nothing has changed and neither will it so lets stop wasting our time and energy on reciting research and studies which I personally find quite insulting to anyone's level of intelligence. It's like saying 2+2 =4. Of course quality care will disappear and hospital mortality rate increase as obvious and logical as the above mathematical equation that my 6 year old could do. Unfortunately our overpaid NHS managers who want a yet more productive workforce but not prepared to pay for them can't seem to get their heads round simply logic.

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  • I thought the more productive workforce was the one being paid to do the investigations, write reports on them and then file them in the archives to make room for the next investigations, etc.

    and how can you prove 2+2 = 4 maybe more research should be done on that before they continue teaching it in schools

    simple logic certainly isn't taught anymore i the genes for it must have died out

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  • This is the problem that so many people have with believing in self evident truths. Unfortunately they are not always right so you have to look at what the evidence says which is where research comes in.

    Try looking out of the window and deciding if the world is round or flat without reference to the hard evidence you have seen that it is in fact round.

    Don't have a go at the people who are trying to provide the evidence to support your argument. These people are in fact on your side.

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  • la di da, di da!

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  • "Try looking out of the window and deciding if the world is round or flat without reference to the hard evidence you have seen that it is in fact round."

    without access to the evidence to the contrary, my world outside my window appears flat, apart from a few little 4000m peaks called the Alps. What does this tell me about nurse staffing levels and mortality?

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