Nurse Staffing and Education Linked to Reduced Patient Mortality

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.

Start Now to Improve Your Organization’s Climate

Start Now to Improve Your Organization’s Climate

 Any nurse knows a well-run unit has excellent staffing and dedicated workers. But such a cohesive environment also has something not so easily defined, says Dr. Jeannie Cimiotti, DNSc, RN, an associate professor at Rutgers University College of Nursing and the executive director of the New Jersey Collaborating Center for Nursing.

The key, she says, is the organization’s climate, one that supports nurses and nursing work from the top down. Because you never know what might happen on any given day, adequate staffing is important, but what really makes a nurse’s job easier isn’t always the number of patients he or she is charged with or the number of hours worked every week. Rather, says Cimiotti, it is the feeling that your colleagues have your back and that your work as a nurse is valued throughout the organization.

While many places are starting to recognize how all these factors work together, nurses have known it, and lived it, for years. When Dr. Marlene Kramer studied nursing in the 1980s, she and her colleagues found the best run medical facilities have some of the same characteristics as the top corporations. “They had good work relationships and all worked together for the good of the organization or of the patient,” Cimiotti says. Simply put, if nurses are overworked and not supported, the quality of care suffers and costs increase.

What can you do if you don’t feel supported by your organization or if, as a supervisor, you would like to see your unit operating more effectively?

Cimiotti suggests taking steps with your colleagues first and then branching out to eventually include the higher ups in your workplace. “You have to develop a culture on the unit and make sure everyone is working for the good of the patient,” she says. A supervisor can analyze satisfaction surveys and bring in the team to brainstorm ideas for improvement. Maybe patients are unhappy with something that can be easily fixed. As a staff nurse, you can bring attention to a procedure that can be done differently or follow up on a suggestion from a patient to improve care in some way.

Be sure the whole nursing team is involved including senior RNs, new nurses, LPNs, and aides. Everyone is vital to the team and when all nurses feel like their voices are being heard, they will work as a team of colleagues.

Once your unit is working cohesively, bring that to the attention of higher ups. Invite them to hear the nurses tell how they reduced their infection rate or increased the patient satisfaction surveys by several points. If you really want to get some attention, attach dollar amounts saved by new processes, because saving money while increasing patient satisfaction or being more efficient is a concrete way to show improvement.

In the end, any steps you can take to improve the organizational climate works in the favor of both nurses, who feel more supported, and patients, who receive the benefits of better quality of care.