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Study Evaluates Nurse Staffing and Education in Relation to Patient Death

Mar 5, 2014

An increase in education and decrease of staffing cuts for nurses could reduce a patient’s chance of dying in a hospital, according to the findings of a new Lancet study published online on February 26th. The study, called RN4CAST, aimed “to inform decision making about nursing, one of the largest components of hospital operating expenses” by analyzing patient to nurse ratios and nurses’ educational background in nine European countries.

Overall, the study found that adding one patient to a nurse’s workload increased the chances of inpatient death by 7 percent within 30 days of admission to a hospital and every 10 percent increase in bachelor’s degree nurses decreased this risk by 7 percent. This data suggests that patients are 30 percent less likely to die in hospitals where nurses care for an average of 6 patients and 60 percent of nurses had bachelor’s degrees compared to hospitals where nurses care for an average of eight patients and only 30 percent have bachelor’s degrees.

“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,” the authors wrote.

Researchers analyzed discharge data for 422,730 patients aged 50 years and older who underwent common surgeries in 300 hospitals across nine European countries: Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden, and Switzerland. Nurse staffing and education was measured by surveying 26,516 nurses in these hospitals.

The authors of the study wrote that limiting or constraining hospital expenditure and growth is a common policy goal in Europe, despite fears that this could affect the quality of patient care. “Hospitals are a target for spending reductions,” they said. Researchers said that nursing is a “so-called soft target” since money can be saved quickly by reducing the nursing staff, whereas the cost of actually improving the efficiency of care is more complex.

The authors point out that these cuts end up making things worse for the patient; England’s Francis Report pointed out how nurses were criticized for not being able to prevent poor care after staffing was cut and the Keogh review, which looked at 14 hospital trusts in England, found that inadequate nurse staffing was strongly associated with consistently high mortality rates.

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