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Lack of nurses linked to increased risk of patient death

Too few fully trained nurses on wards increases risk of patient death by 3% per day

Ingrid Torjesen

Wednesday, 05 December 2018

Admission to a hospital ward with below average numbers of fully trained (registered) nurses is linked to a 3% increased risk of death for each day the shortfall persists, suggests UK research* published online in the journal BMJ Quality & Safety.

The proportion of fully trained registered nurses on hospital wards in the UK is among the lowest in Europe, and many hospitals now rely on unregistered nursing assistants to provide a substantial amount of hands-on care, say the researchers. However, trying to plug the gap with unregistered nursing assistants doesn’t reduce the risk of patient harm, the research shows.

The researchers looked at 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 this period 138,133 adults spent at least one day on general medical and surgical wards, and most (79%) were admitted as emergencies. Their average age was 67; 14% were aged 85 and older.

Staffing levels were measured as hours per patient per day. Across all the wards, staffing levels for registered nurses averaged 4.75 hours, while those for nursing assistants averaged 2.99 hours.

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 4% (5662 deaths) but analysis of the data showed that the odds of dying rose by 3% for each day that a patient spent on a ward with a below average registered nurse staffing level.

Days where the number of admissions for each registered nurse was substantially higher than usual - more than 25% above average -were associated with a 5% heightened risk of death.

Low nursing assistant staffing levels were also associated with a heightened risk of death (4%), but so was above average staffing levels.

Each additional hour of care provided by a registered nurse was associated with a 3% reduction in the chances of dying, the analysis showed. But no such impact was observed for additional hours of care provided by nursing assistants.

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.

“The findings of this paper suggest potential benefits from increasing the availability of [registered nurses] on acute hospital wards,” the researchers said.


*Griffiths P, Maruotti A, Recio Saucedo A, et al. Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf Published Online First: 04 December 2018. doi: 10.1136/bmjqs-2018-008043

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