Lack of nurses on hospital wards linked to rise in patient death risk

A lack of fully trained nurses on hospital wards leads to a daily rise in the risk of patients dying, warns a new study.

Researchers found admission to a hospital ward with below average numbers of fully trained, or registered, nurses to care for patients is linked to a three per cent rise in the risk of death for each day the shortfall persists.

But plugging the gap with unregistered nursing assistants isn’t associated with any reduction in patient harm, according to the findings published online by the journal BMJ Quality and Safety.

Researchers say that suggests that while nursing assistants have a key role in maintaining ward safety, “they cannot act as substitutes” for registered nurses.

Study author Professor Peter Griffiths, of the University of Southampton, said the proportion of fully trained registered nurses on hospital wards in Britain is among the lowest in Europe.

And many hospitals now rely on unregistered nursing assistants to provide a substantial amount of hands-on care, according to the researchers.

To find out what impact the skill mix might be having on patient safety in hospital wards, the researchers drew on routinely collected data for staffing levels for all adults admitted to 32 wards in one large acute care hospital trust in the South of England between April 2012 and March 2015.

During that period, 138,133 adults spent at least one day on general medical and surgical wards, and most (79 per cent) were admitted as emergencies. Their average age was 67; 14 per cent were aged 85 and older.

Staffing levels were measured as hours per patient per day.

But across all the wards, staffing levels for registered nurses averaged 4.75 hours, while those for nursing assistants averaged 2.99.

Over the first five days of their stay, patients experienced, on average, nearly two days of low (below average) registered nurse and nursing assistant staffing levels, adding up to a cumulative shortfall of 23 and 15 minutes, respectively, each.

During the study period, the overall death rate was just over four per cent (5,662 deaths).

Analysis of the data showed that the odds of dying rose by three per cent for each day that a patient spent with registered nurse staffing levels below the average for that ward.

Although low nursing assistant staffing levels were also associated with a heightened risk of death (four per cent), so too were above average staffing levels.

Days where the number of admissions for each registered nurse was substantially higher than usual – more than 25 per cent above average – were associated with a five per cent heightened risk of death.

Each additional hour of care provided by a registered nurse was associated with a three per cent reduction in the chances of dying, according to the analysis.

But no such impact was observed for additional hours of care provided by nursing assistants.

Based on their figures, the researchers suggest that providing one additional hour of registered nurse care would be the equivalent of one extra nurse on each shift for a 24-bed ward.

They said it was an observational study, so can’t establish cause.

But the researchers said that their findings were broadly in line with those of other previously published studies.

Prof Griffiths said: “The findings of this paper suggest potential benefits from increasing the availability of registered nurses on acute hospital wards.”

But he added: “However, in England, RN shortages look set to continue in the short term.

“These are unlikely to be remedied by increasing the numbers of lesser trained nursing staff in the workforce.”


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