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The University of Southampton
Health Sciences

Degree educated nurses can reduce hospital deaths

Published: 26 February 2014

Hospital nurse staffing, and the proportion of nurses with bachelor’s education, are associated with significantly fewer deaths after routine surgery, according to research published today in the Lancet.

A team of researchers, including lead investigators from England, Professor Peter Griffiths from the University of Southampton and Professor Anne Marie Rafferty from the Florence Nightingale School of Nursing and Midwifery, King's College London, conducted the study across nine European countries and found that a better educated nursing workforce reduced unnecessary deaths. Every 10 per cent increase in the number of bachelor's degree educated nurses within a hospital is associated with a seven per cent decline in patient mortality

Patients in hospitals, in which 60 per cent of nurses had bachelor's degrees and nurses cared for an average of six patients, had almost 30 per cent lower mortality than patients in hospitals in which only 30 per cent of nurses had bachelor's degrees and nurses cared for an average of eight patients. The study shows that, in hospitals in England, an average only of 28 per cent of bedside care nurses had bachelor's degrees, amongst the lowest in Europe, which averaged 45 per cent.

The study shows that increasing the production of graduate nurses is necessary if the NHS is to realise the potential of lower patient mortality and fewer adverse patient outcomes.

Professor Peter Griffiths, Chair of Health Services Research at the University of Southampton, was the lead research on gathering information on patient deaths for the study. He comments ‘The study highlights two very important issues. One is that the number of trained nurses on hospital wards is a crucially important factor in ensuring that patients are safe; it makes it absolutely clear that low staffing levels are dangerous.

‘The other issue that is highlighted is nurse education. There has been a massive backlash against educating nurses to degree level. These findings from nine European countries shows that hospitals, which employ more degree qualified nurses, have a lower rate of mortality compared to hospitals with fewer degree qualified nurses. In the face of these figures, it is hard to conclude that degree educated nurses are to blame for failings in the NHS. It is more likely that, where nursing has failed, it is because of inadequate resources and support by NHS managers in some hospitals.'

Professor Anne Marie Rafferty, Florence Nightingale School of Nursing and Midwifery, King's College London, and the lead investigator for England on the study said, ‘The assumption that hospital nurse staffing can be reduced to save money, without adversely affecting patient outcomes, may be foolish at best and fatal at worst. In this post-Francis Report era, it is vital that investment in nurse staffing is evidence based. Our evidence demonstrates that it is not only quantity but the quality of the workforce that counts. The size and scale of these findings across the EU confirms previous evidence from England demonstrating that better educated nurses, caring for fewer patients, with lower workloads reduces patient mortality.

‘We demonstrate that an increase in nurses' workloads by one patient increases the likelihood of inpatient hospital mortality by seven per cent, and a 10 per cent increase in bachelor's degree nurses is associated with a decrease in odds on mortality by seven per cent, clearly showing that an increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Hospitals should take notice because when budgets are tight, cutting back on nurses is often the first step, but the study has shown that this can have disastrous consequences for patients.'

The RN4CAST study was designed to assess whether differences in patient to nurse ratios and nurses' educational qualifications, in nine countries with similar patient discharge data, were associated with variation in hospital mortality after common surgical procedures. The team also found that every one patient increase in patient to nurse ratios was associated with a 7 per cent increase in deaths.

The study was funded by the European Union and the National Institute of Nursing Research, National Institutes of Health, and concluded that in England, as in the U.S., failing to invest in bachelor's degree nurse education and attempts to cut costs by reducing nurse staffing may put hospitalized patients at greater risk of dying.

Notes for editors

 1. A copy of the paper is available from Media Relations upon request or available for journalists at

 2.  The University of Southampton is a leading UK teaching and research institution with a global reputation for leading-edge research and scholarship across a wide range of subjects in engineering, science, social sciences, health and humanities.

With over 23,000 students, around 5000 staff, and an annual turnover well in excess of £435 million, the University of Southampton is acknowledged as one of the country's top institutions for engineering, computer science and medicine. We combine academic excellence with an innovative and entrepreneurial approach to research, supporting a culture that engages and challenges students and staff in their pursuit of learning.

The University is also home to a number of world-leading research centres including the Institute of Sound and Vibration Research, the Optoelectronics Research Centre, the Web Science Trust and Doctoral training Centre, the Centre for the Developmental Origins of Health and Disease, the Southampton Statistical Sciences Research Institute and is a partner of the National Oceanography Centre at the Southampton waterfront campus.

3. The Florence Nightingale School of Nursing & Midwifery at King's College London is the world's first professional School of Nursing, established by Florence Nightingale.

The number one Nursing and Midwifery School in London (Complete University Guide 2014) and highly regarded by leading London NHS Trusts with links to industry, health services and policy makers, the School develops leading-edge nurses and midwives of tomorrow - practitioners, partners, and leaders in their field.

The School has over 1,000 full-time students training to be nurses and midwives plus an extensive portfolio of undergraduate and postgraduate activities to meet the needs of a wide range of healthcare professionals seeking continuing professional development. The School is at the forefront of health services, policy and evaluation research and home to the influential National Nursing Research Unit (NNRU). For further information visit:


4. King's College London is one of the top 20 universities in the world (2013/14 QS World University Rankings) and the fourth oldest in England. It is The Sunday Times 'Best University for Graduate Employment 2012/13'. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £554 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit:

The College is in the midst of a five-year, £500 million fundraising campaign - World questions|King's answers - created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health. More information about the campaign is available at

For more information or interview opportunities contact:

Becky Attwood , Media Relations, University of Southampton, Tel: 023 8059 5457, 07545 422512, email:

Oliver Stannard, Communications Officer, Florence Nightingale School of Nursing & Midwifery, King's College London

T: 020 7848 3062 M: 07941 863 881



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