Study: Fewer Nurses and Less Education Linked to Higher Hospital Mortality

A new study published in the Lancet evaluates patient to nurse ratios and nurses’ educational background in relation to inpatient hospital deaths. The authors of the study, entitled RN4CAST, found that mortality rates increased with increased nurse workload and decreased when more nurses has bachelor’s degrees in nine European countries.

The study, which was published online on February 26^th, aimed “to inform decision making about nursing, one of the largest components of hospital operating expenses”. According to the authors, policies frequently try to constrain hospital expenditure and growth, even though there are concerns that this might compromise patient safety. “Hospitals are a target for spending reductions.” they wrote, and nursing is a “so-called soft target because staff cuts quickly save money. The actual cost of improved efficiency is much more difficult, they wrote. The researchers cited two other studies showing that highlight the effects of nursing staff cuts; England’s Francis Report discusses how nurses were criticized for not being able to make up for poor care after staffing was cut and the Keogh review, which looked at 14 hospital trusts in England, found that inadequate nurse staffing was an important factor for consistently high death rates.

Researchers used discharge data from 422,730 patients older than 50 years old in 300 hospitals across Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden, and Switzerland. Surveys among 26, 516 nurses in participating study hospitals measured staffing and educational qualifications.

The study found that adding one patient to a nurse’s workload increased the chances of

patient death by 7 percent within 30 days of admission to a hospital; this risk decreased by 7 percent for every 10 percent increase in bachelor’s degree nurses. These findings suggest that patients in hospitals where nurses care for an average of 6 patients and 60 percent of nurses had bachelor’s degrees have a 30 percent lower mortality compared to those in 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.