"Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational studySummaryBackground
Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures.
For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics.
An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1-068, 95% CI 1-031--1-106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0-929, 0-886--0-973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients.
Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths."
Quote from MunoRN
I think the study objectives can be questioned just based on the study objectives, and while the confounding variables aren't ideal, it's nothing compared to the ridiculousness of the findings. Does it really seem believable that we could take a nurse's workload, say a workload that is currently 1:5, and double that workload to 1:10, and have no affect on patient mortality so long as we increase the composition of BSN nurses from 30% to 80%? I don't think "flawed" sufficiently describes such a claim.
Can you explain: "the study objectives can be questioned just based on the study objectives"? I don't follow you there.
Have you read the full text of the paper? Can you cite where they comment that the results could be extrapolated to a 1:10 ratio? It does not address that at all in the paper from my reading.
Last edit by BostonFNP on Mar 11, '14