Degree educated nurses can reduce hospital deaths

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 researcher 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.