There is a link between higher death rates and the number of healthcare assistants employed in NHS hospitals, suggests latest nursing research.
A study by the University of Southampton found trusts with a higher number of unregulated HCAs also had a higher mortality rate.
It used survey data from almost 34,000 nurses, which formed part of the seminal RN4CAST nursing workforce study that was published last July. It also examined details of the workforce, bed occupancy and bed numbers for 137 acute hospital trusts and calculated the mortality rates based on the actual number of deaths, compared to the numbers predicted for each trust.
A higher HCA-to-bed ratio increased the mortality rate up to a maximum of 5.4% more than would be expected, the new study found. Across the trusts in the study, HCA-to-bed ratios ranged from 32 assistants per 100 beds to 109 assistants per 100 beds. The average was 66 HCAs per 100 beds.
The study also identified a clear link between the number of registered nurses and mortality. It found there were fewer deaths the more nurses were employed. For every 10% increase in the number of registered nurses the odds of patients dying dropped by almost 7%.
Based on hospital admissions in 2010-11, the study found a 10% increase in the number of nurses would result in 2,600 fewer deaths.
The research was presented last week at the Royal College of Nursing’s International Nursing Research Conference in Belfast.
Lead study author Professor Peter Griffiths told Nursing Times the findings on HCAs needed further investigation, but said: “It certainly calls into question a workforce strategy that moves registered nurses further away from the bedside and replaces them with assistants.
“This echoes some of the findings of the [Mid Staffordshire Public Inquiry] report, which expressed concern over the lack of regulation for this workforce.”
Professor Griffiths added: “The fewer registered nurses a hospital has, the more patients die. So the significance of nurse staffing levels seems to be well established both in the research and in the tradition of the profession.”
He added that, while the government appeared “dead set” against introducing mandatory staffing levels, “there is surely a level at which we can be clear it cannot be safe under any circumstances.”
He suggested a ratio of eight patients per nurse, saying in his study 60% of shifts were at this level or better.
“The findings taken as a whole point to the need for more qualified nurses at the bed side,” Professor Griffiths said. “It is hard to conclude from this evidence that the solution lies in downgrading the training of the nursing workforce as a whole and reducing the number of registered nurses.”
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