British Research Finds Temporary or Reduced Nurse Staffing Increases Patient Death Risk
Emerging findings from a new British study believed to be the first of its kind found the risks of a patient dying increases “significantly” after time in the hospital during which the number of nurses falls below the required level.
Prior research had been contested because it had not been possible to show how staffing was directly associated to mortality and only was able to show an association. The Nursing Times noted that data has also been based overseas.
In the latest study at a National Health Trust (NHS) trust, academics from the University of Southampton revealed that, over the first five days of hospitalization, for every day a patient was on a general medical or surgical ward with nurse staffing lower than what was typically required, the risk of death increased by three percent. High-risk patients—with an early warning score above six- were at greater risk of their observations not been taken when they were on a ward with a reduced number of nurses, according to Nursing Times.
The results from the study, entitled “Nurse Staffing, Missed Vital Signs, Observations, and Mortality in Hospital Wards,” has not been published in full; however early findings were presented at the Royal College of Nursing’s international nursing research conference in Oxford this month, Nursing Times noted.
“This is an early analysis, but these latest findings are consistent with a growing body of research that suggests having sufficient numbers of professional nurses spending time with patients and providing direct care will result in the best outcomes,” said Professor Peter Griffiths, who led the research. “This is one of the first studies that directly links the nursing a patient receives to outcomes,” he told Nursing Times. “The problems associated with the use of temporary nurses shown here highlights problems that arise from the significant shortage of nurses that is being experienced by the NHS,” he pointed out.
The researchers also learned that, for every additional hour of care provided to a patient by a nurse during a 24-hour time frame, a two percent decrease in the likelihood of vital signs observations being missed was seen. Also increased levels of temporary nurse staffing were associated with an increased risk of patient death. In fact, when 1.5 or more hours of nursing care was given by temporary nurses to a patient in a 24-hour period, the risk of mortality was increased by 12 percent, Nursing Times reported.
The hospital’s average number of hours of nurse care per patient per day was 4.7. According to Nursing Times, this indicates that, when approximately one-third of those hours were delivered by a temporary nurse and not a permanent nurse, the risk of patient death increased.
The research also revealed that patients whose stays occurred during a high patient turnover, as far as terms of admissions per nurse were concerned, a significant risk of death was associated, wrote Nursing Times. For every day in which a patient was being treated on a general ward staffed below what was required in terms of the number of care assistants, mortality risks increased by four percent.
Study results were based on data from 32 general medical and surgical wards in a large NHS hospital in England between 2012 and 2015. The research involved analyzing approximately 914,000 patient days from approximately 111,000 patients and three million sets of vital sign observations. In all, 5.2 percent of patients died in the hospital in the three-year time frame, according to Nursing Times.
Professor Griffiths also said that the national shortage of nurses may become worse in the future because of the requirement for students to take out loans for nursing training this year. Professor Griffiths noted that applications for pre-registration nursing courses dropped in comparison to last year. The study results, which revealed increased temporary staffing raised risks of mortality, also revealed the potential consequences of future shortages and managers may be forced to fill more shifts with agency or bank workers he added, according to Nursing Times.
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Prior Research on Nurse-to-Patient Mortality Ratios
Research entitled “Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices” that was published in the journal Agency for Healthcare Research and Quality (U.S.) in March 2013 also found that a percentage of hospitalized patients die either during or soon after their hospitalization. The researchers found that some of the deaths may have been prevented with more nursing care.
A prior study of 232,342 surgical discharges from a number of Pennsylvania hospitals revealed that 4,535 patients, or two percent, had died within 30 days of hospital admission. The researchers determined that the difference between 4:1 and 8:1 nurse-to-patient staffing ratios might be some 1,000 deaths. Other studies have revealed roughly similar estimates, or approximately one to five fewer deaths per 1000 inpatient days.
The researchers concluded that, “ Nurse staffing ratios have a consistent association with reductions in hospital-related mortality. However, the strength of evidence for causality in this finding cannot be rated high, given the lack of evaluations of a deliberate change in RN staffing from some initial value…. Such an evaluation should be possible, either as a time series analysis or as a controlled before-and-after analysis. Studies evaluating a deliberate change in nurse staffing ratios would greatly improve our understanding of the likelihood of causality. Developing a testable conceptual framework for how increased staffing can influence outcomes would be an important addition to these and other studies…. If the relationship between nurse staffing and mortality outcomes is causal, then the wide variety of hospital settings included in existing analyses suggests that the effect is likely to be relatively insensitive to hospital contexts. However, some of the nurse work environment factors, such as job satisfaction, burnout, teamwork, workload, and leadership, are potentially important effect modifiers, and this area merits further study.”
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