Nursing staff cuts associated with increased risk of preventable deaths

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1. Every one patient increase per nurse workload is associated with a 7% increase in the likelihood of a surgical patient dying within 30 days of admission.

2. Every 10% increase in number of nurses with a bachelor’s degree in a hospital is associated with a 7% decrease in the likelihood of a surgical patient dying within 30 days of admission.

Evidence Rating Level: 2 (Good)

Study Rundown: Recent policy reforms in Europe aimed at shortening hospital stays would result in intensified nursing care of inpatients, raising concerns of adverse outcomes for quality of care. This study sought to inform the decisions around this key issue, and concluded that both nurse staffing and nurses’ education were significantly associated with mortality. These results challenge the recent European Union decision to continue endorsing vocational nursing education after only 10 years of general education.

Notable limitations in this study were that the definition of a bachelor’s nursing education differs by country, care of individual patients could not be linked to individual nurses, and the cross-sectional data limited information about causality. However, this study is the broadest and most rigorous analysis of nursing and hospital outcomes in Europe to date, and the data are representative of national differences in Europe, providing strength in its claim.

Click to read the study in The Lancet

Relevant Reading: Educational Levels of Hospital Nurses and Surgical Patient Mortality

In-Depth [retrospective observational study]: This study assessed whether differences in nurses’ education and patient to nurse ratios were associated with variation in mortality following common surgeries. Mortality data for 422,730 patients aged 50 years or older that underwent common surgeries in 300 hospitals in nine European countries were obtained. Nurse staffing and education measures were derived from responses to 26516 surveys in each hospital with the RN4CAST survey instrument designed to inform policymakers how to get the best value for nursing workforce investments. Response rates to surveys varied from less than 40% (2990 of 7741) in England, to nearly 84% (2804 of 3340) in Spain, and averaged 62% (29,251 of 47,160) across all countries. Associations between nurse staffing and nurses’ education and 30-day inpatient mortality for patients were estimated before and after adjusting for hospital characteristics and patient risk factors. The results revealed that an addition of one patient to a nurses’ workload increased the likelihood of inpatient mortality within 30 days of admission by 7% (odds ratio 1.068, 95% CI 1.031–1.106), while every 10% increase in number of nurses with a bachelor’s degree was associated with a decrease in this likelihood by 7% (0.929, 0.886–0.973).

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