Fewer nurses may mean more deaths
26th February 2014 – Cuts to nursing staff have a measurable impact on death rates among patients recovering from common surgical procedures, say researchers.
A study across 9 European countries, including England, say patients are more likely to die in hospitals where nurses have heavier workloads and when fewer are qualified to university degree level.
The study in The Lancet used hospital discharge records for 422,730 patients aged 50 and over who underwent common surgical procedures requiring a stay of at least 2 days in 300 hospitals – 30 of them in England. Operations included hip or knee replacement, appendix removal, gall bladder surgery and vascular procedures.
The findings indicate that every extra patient added to a nurse’s average workload increases the chance of patients dying within 30 days of admission by 7%.
However, this risk can be offset when nursing staff have higher qualifications. A 10% increase in the proportion of nurses holding a bachelor degree is associated with a 7% decrease in the risk of death, say the authors.
Lead researcher Professor Linda Aiken from the University Of Pennsylvania School of Nursing in the US says in a statement: "Our findings emphasise the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelor’s education for nurses could reduce hospital deaths."
Nurse staffing (workload) and education levels varied widely both between countries and between hospitals within each country. The average ratio was 8.8 in England compared to 12.7 in Spain and 5.2 in Norway.
In hospitals in England, an average only of 28% of bedside care nurses had bachelor’s degrees, amongst the lowest in Europe, which averaged 45%. In Spain and Norway, all nurses had a degree, although in Switzerland the figure was only 10%.
The findings suggest that patients have the highest risk of death after surgery in hospitals where nurses with lower levels of education care for more patients. For example, in hospitals where nurses care for an average of 6 patients each, and the proportion of nurses with bachelor’s degrees is 60% or greater, the risk of hospital deaths would be almost 30% lower than in hospitals where nurses care for an average of eight patients, and in which only 30% of nurses have degrees.
The authors note that their findings in Europe closely mirror those from the USA.
Education v experience
"Our data suggest that a safe level of hospital nursing staff might help to reduce surgical mortality, and challenge the widely held view that nurses' experience is more important than their education," says Professor Aiken.
Another of the researchers, Professor Peter Griffiths, from the University of Southampton, adds in a statement: "There has been a massive backlash against educating nurses to degree level. These findings from nine European countries shows that hospitals, which employ more degree qualified nurses, have a lower rate of mortality compared to hospitals with fewer degree qualified nurses.