March 10, 2014

Nurse Staffing, Education Affect Patient Safety

Nurse helping hospital patient.

Patient deaths in hospitals might be reduced by easing nurses’ workloads and emphasizing education in hiring, a new study suggests. The findings can help administrators make informed staffing decisions.

Decision-makers must plan nurse workforces in the face of scarce resources and health care reforms. Past studies of how nurse staffing and education affect patient outcomes led the Institute of Medicine to recommend that 80% of nurses in the U.S. have a bachelor’s degree by 2020. Many hospitals now aim to hire more bachelor’s degree-trained nurses, and nearly 25 U.S. states have proposed or enacted legislation to improve hospital nurse staffing.

A research team led by Dr. Linda Aiken of the University of Pennsylvania and Dr. Walter Sermeus of the Catholic University of Leuven in Belgium analyzed patient outcomes associated with nurse staffing and education in 9 European countries. The scientists reviewed the hospital discharge data of more than 420,000 patients who underwent common surgeries. The researchers also surveyed more than 26,500 nurses in the study hospitals to measure nurse staffing and education levels.

The team assessed how these nursing factors affected the likelihood of patients dying within 30 days of hospital admission. The study was supported by the European Union’s Seventh Framework Programme and NIH’s National Institute of Nursing Research (NINR). Results were published online in the Lancet on February 25, 2014.

The researchers estimated that each additional patient in a hospital nurse’s workload increased the likelihood of a patient dying within 30 days of admission by 7%. Nurse education also affected outcomes. A better educated nurse workforce was associated with fewer deaths. For every 10% increase in nurses with bachelor’s degrees, there was a drop in the likelihood of patient death by 7%.

In hospitals where 60% of nurses had bachelor’s degrees and cared for an average of 6 patients, the researchers calculated, the likelihood of patients dying after surgery was nearly one-third lower than in hospitals where only 30% of nurses had bachelor-level education and cared for an average of 8 patients.

“Our study is the first to examine nursing workforce data across multiple European nations and analyze them in relation to objective clinical outcomes, rather than patient or nurse reports,” Aiken says. “Our findings complement studies in the U.S. linking improved hospital nurse staffing and higher education levels with decreased mortality.”

“This study emphasizes the role that nurses play in ensuring successful patient outcomes and underscores the need for a well-educated nursing workforce,” says NINR Director Dr. Patricia A. Grady.

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References: Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, Diomidous M, Kinnunen J, Kózka M, Lesaffre E, McHugh MD, Moreno-Casbas MT, Rafferty AM, Schwendimann R, Scott PA, Tishelman C, van Achterberg T, Sermeus W; for the RN4CAST consortium. Lancet. 2014 Feb 25. pii: S0140-6736(13)62631-8. doi: 10.1016/S0140-6736(13)62631-8. [Epub ahead of print]. PMID: 24581683.

Funding: NIH’s National Institute of Nursing Research (NINR); European Union's Seventh Framework Programme; Norwegian Nurses Organisation; Norwegian Knowledge Centre for the Health Services (IMH); Swedish Association of Health Professionals; Stockholm County Council; Karolinska Institutet; and Spanish Ministry of Science and Innovation.