More, and more educated, nurses make a difference

Whilst I was wandering around Cornwall last week (see photograph for evidence), The Lancet was busy publishing the latest paper from Professor Linda Aiken and her colleagues in the RN4CAST consortium. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study uses discharge data for 422,730 surgical patients in 300 hospitals in nine countries along with survey data from 26,516 practising nurses. That’s one big study. The abstract goes on to say:

An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031—1·106), and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886—0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients.
Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths.

[NB: Not sure about odds ratio? Check out the relevant Wikipedia entry here.]

On the day the article was published in early online form the Council of Deans of Health here in the UK ran with this, The Conversation ran with this and The Guardian ran with this. The Lancet supplemented its article with this podcast.

The media interest reflects the scale of the study and the importance of its findings, which make a strong case for investment in nursing. A year ago, the International Journal of Nursing Studies published this special issue on the nursing workforce and outcomes, carrying a series of open access papers from the same RN4CAST team. There are other papers published elsewhere arising from this same study, and no doubt more to come.

What the RN4CAST researchers have not done is to have generated any data in psychiatric hospitals or involving mental health nurses. This is very reasonable, as theirs has been a complex-enough study ‘focused on general acute hospitals’, to quote from its published protocol. But it would be good to know more of the relationships across Europe between mental health nurse staffing and practitioner characteristics, organisational and management features and service user outcomes. Now there’s a challenge for someone.


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