Nurse Staffing and Education Linked to Reduced Patient Mortality

Hospitals in Europe where nursing staff care for fewer patients and have a higher proportion of bachelor’s degree-trained nurses had significantly fewer surgical patients die while hospitalized, according to a new study. These findings underscore the potential risks to patients when nurse staffing is cut and suggest an increased emphasis on bachelor’s education for nurses could reduce hospital deaths.

The study, supported by the European Union’s Seventh Framework Programme and the National Institute of Nursing Research (NINR), part of the National Institutes of Health, is the largest and most detailed analysis to date of patient outcomes associated with nurse staffing and education in Europe. Known as Registered Nurses Forecasting (RN4CAST), the study estimated that an increase in hospital nurses’ workloads by one patient increases the likelihood of in-hospital death by 7%. Also, a better educated nurse workforce was associated with fewer deaths. For every 10% increase in nurses with bachelor’s degrees, there was an associated drop in the likelihood of death by 7%. The results of the study are published in the February 25 issue of The Lancet.

“Building the scientific foundation for clinical practice has long been a crucial goal of nursing research and the work supported by NINR,” said NINR Director Patricia A. Grady. “This study emphasizes the role that nurses play in ensuring successful patient outcomes and underscores the need for a well-educated nursing workforce.”

For the RN4CAST study, a consortium of scientists led by Linda Aiken of the University of Pennsylvania School of Nursing, Philadelphia, and Walter Sermeus of the Catholic University of Leuven in Belgium, reviewed hospital discharge data of nearly 500,000 patients from nine European countries who underwent common surgeries. They also surveyed over 26,500 nurses practicing in study hospitals to measure nurse staffing and education levels. The team analyzed the data and surveys to assess the effects of nursing factors on the likelihood of patients dying within 30 days of hospital admission.

Based on their analysis, the researchers estimated that patients in hospitals where 60% of nurses had bachelor’s degrees and cared for an average of six patients had a nearly one-third lower risk of dying in the hospital after surgery than patients in hospitals where only one-third of nurses had a bachelor’s level education and cared for an average of eight patients each.

“Our study is the first to examine nursing workforce data across multiple European nations and analyze them in relation to objective clinical outcomes, rather than patient or nurse reports,” said Aiken. “Our findings complement studies in the US linking improved hospital nurse staffing and higher education levels with decreased mortality.”

In the US, analysis of patient outcomes associated with nurse staffing practices has informed proposed or actual legislation in nearly 25 states. These types of analyses also informed the recommendation of the Institute of Medicine that 80% of nurses in the US have a bachelor’s degree by 2020. Hospitals have responded to this recommendation with preferential hiring of bachelor’s degree-trained nurses.

The RN4CAST study was designed to provide scientific evidence for decision makers in Europe to guide planning for the nurse workforce for the future. The study’s findings provide evidence to guide important decisions about improving hospital care in the context of scarce resources and health care reforms.

“This study is another example of how nursing science can help inform policies that promote positive patient outcomes not only in the US, but around the world,” added Grady.