December catch-up

Competing priorities have kept me away from this site in recent weeks. There’s been work to do on COCAPP, which is close to the finish line, and doctoral students’ drafts to read and comment on (before imminent thesis submission, in one case). I’ve also been reading a thesis ahead of a PhD examination I’m involved in at the end of the coming week. So if this catch-up post feels a little bitty, then that’s because it is: there’s been lots happening that I want to comment on.

First up is the RiSC study, which I’ve mentioned here plenty of times before. In the last ten or so days the NIHR has published a first look summary of our aims, methods and findings. This is a precursor to the publication of our whole report, which is now post-peer review. Sometime in the new year we’ll be reconvening as a research team to plan our next project.

In October I made the short trip to the University of South Wales to hear Professor Linda Aiken from the University of Pennsylvania deliver this year’s RCN Winifred Raphael Lecture. Professor Aiken spoke on Quality nursing care: what makes a difference?, drawing on findings from the RN4Cast study and more. As promised, the RCN Research Society has now uploaded its video of the event for the world to see. It’s well worth watching.

News on the Mental Health Nurse Academics UK front includes an election, which we are now midway through, for the group’s next Vice Chair and Chair Elect. I’m overseeing this process (as I’ve done twice before), and will be in a position to announce the successful nominee on December 15th. One of the things that MHNAUK does is to work with the RCN to run the annual NPNR conference, and I’m very pleased to have had the chance to join the NPNR scientific and organising committee for a three year stint. More to follow on that front in the future, including details of next year’s event as they emerge.

Elsewhere I read that the Shape of Caring review, chaired by Lord Willis, is looking at the UK practice of preparing new nurses, at the point of registration, for work in one of four fields (mental health, adult, child and learning disability). This is something to keep a close eye on, with reports from last month’s Chief Nursing Officer Summit in England suggesting that the fields may be on their way out. For a useful, balanced, review in this area I refer the reader to the 2008 King’s College London Policy+ paper Educating students for mental health nursing practice: has the UK got it right? and, for a longer read, to Approaches to specialist training at pre-registration level: an international comparison.

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.