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Nurse staffing, education affect patient mortality in Europe

Wednesday February 26, 2014
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Patients are more likely to die after common surgical procedures when they are cared for in hospitals with heavier nurse workloads and fewer nurses with bachelorís degrees, according to a study of European hospitals.

The study findings, published Feb. 26 on the website of The Lancet, were derived from more than 420,000 patients in 300 hospitals across nine European countries. The findings indicate that every extra patient added to a nurseís average workload increases a surgical patientís chance of dying within 30 days of admission by 7%.

A 10% increase in the proportion of nurses holding a bachelor degree is associated with a 7% decrease in the risk of death, researchers reported.

ďOur findings emphasize the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelorís education for nurses could reduce hospital deaths,Ē Linda Aiken, RN, PhD, FAAN, FRCN, the studyís lead investigator and a professor at the University of Pennsylvaniaís School of Nursing in Philadelphia, said in a news release.

To assess whether differences in patient-to-nurse workloads and nursesí educational qualifications affect patientsí survival after surgery, the researchers analyzed responses from more than 26,500 nurses, and reviewed medical records for 422,730 patients ages 50 or older who were discharged after common surgery such as hip or knee replacement, appendectomy, gall bladder surgery and vascular procedures in nine European countries (Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden and Switzerland).

The analysis examined the association of nursing workload and education with patient outcomes, after taking into account each individual patientís risk of death including age, sex, type of surgical procedure, type of admission and the presence of chronic conditions such as hypertension or diabetes, as well as hospital characteristics including bed size, teaching status and technology availability.

The overall percentage of patients who died in hospital within 30 days of admission was low, ranging by country between 1% and 1.5%. However, in every country, death rates varied significantly across individual hospitals, ranging from hospitals where less than 1% of patients died to hospitals where more than 7% died.

Nurse staffing and education levels varied widely both between countries and between hospitals within each country. In Spain and Norway, all nurses had a bachelorís degree compared with an average of just 10% in Switzerland and 28% in England.

The findings suggest patients have the highest risk of death after surgery in hospitals where nurses with lower levels of education care for more patients. For example, in hospitals where nurses care for an average of six patients each, and the proportion of nurses with bachelorís degrees is 60% or greater, the risk of dying in the hospital would be almost 30% lower than in hospitals where nurses care for an average of eight patients and in which only 30% of nurses have bachelorís degrees.

The authors note their findings in Europe closely mirror those from the U.S. ďOur data suggest that a safe level of hospital nursing staff might help to reduce surgical mortality, and challenge the widely held view that nursesí experience is more important than their education,Ē Aiken said.

Study abstract: http://bit.ly/1k7O3nR

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