The analysis of staff and patient surveys, staffing data and death rates at 243 hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland shows that for every 25 patients treated, employing one nursing assistant instead of a professional nurse increases the odds of dying in a hospital by 21 percent.
While this may not seem like a great revelation the findings are important because tighter healthcare budgets are leading some countries to employ more lower-skilled nurses and nursing assistants to work under the management of experienced nurses. The National Health Service in England, for example, is about to introduce a new nursing associate role.
The researchers, led by Linda Aiken of the University of Pennsylvania, argue there is a lack of evidence supporting political decisions to lower the nursing skills mix in hospitals.
There is a wide variability in the nursing skills mix in Europe. Germany has the largest proportion of professional nurses (82 per cent) among the countries in the study, while England at 57 per cent and Spain, 54 per cent, rank the lowest.
According to the study, “Richer nurse skills mix (for example, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11 per cent increase in the odds of death.”
“In our hospital sample, there was an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21 per cent increase in the odds of dying,” the study finds.
“A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.”
Aiken LH, Sloane D, Griffiths P, et al. BMJ Qual Saf Published Online First: 15 Nov 2016 doi:10.1136/bmjqs-2016-005567
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