New Study Shows Nurse Education Level, Caseload Affect Patient Mortality

  1. 5 "Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

    Summary

    Background

    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.

    Methods

    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.

    Findings

    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.

    Interpretation

    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."

    http://www.thelancet.com/journals/la...631-8/abstract


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  3. Visit  wtbcrna} profile page

    About wtbcrna, MSN, DNP, CRNA

    From 'US'; 42 Years Old; Joined Jul '05; Posts: 4,528; Likes: 4,453.

    31 Comments so far...

  4. Visit  SHGR} profile page
    3
    Those findings are impressive. Even more impressive that this was published in the Lancet as opposed to a nursing journal or Health Affairs.
  5. Visit  MunoRN} profile page
    2
    I was expecting the full text to better clarify the claims in the abstract but it doesn't appear to.

    The (likely unintended) claim appears to be that increasing patient ratios is safe so long as it's offset by increasing the proportion of BSN nurses. So a hospital unit with a patient ratio of 1:5 can and 30% proportion of BSN nurses can safely increase their ratio to 1:10 so long as they increase their proportion of BSN nurses to 80%.
    Not_A_Hat_Person and hope3456 like this.
  6. Visit  DoGoodThenGo} profile page
    5
    Here we go again folks!

    Fasten your seat belts, it's going to be a bumpy night!

    *LOL*
  7. Visit  TriciaJ} profile page
    4
    This study is not new. The BSNs got a shorter load and the ADNs got a heavier load. Which patients did better? What do we naturally conclude? That you can't measure 2 simultaneous variables without a corollary study. Puh-lease! (Unless this is some other study and all the variables were measured separately. Does it say that somewhere?)
    hope3456, Susie2310, Esme12, and 1 other like this.
  8. Visit  MunoRN} profile page
    3
    Quote from TriciaJ
    This study is not new. The BSNs got a shorter load and the ADNs got a heavier load. Which patients did better? What do we naturally conclude? That you can't measure 2 simultaneous variables without a corollary study. Puh-lease! (Unless this is some other study and all the variables were measured separately. Does it say that somewhere?)
    This one is similar to previous Aiken studies but it is actually new, and yes I agree that only one variable should be studied at a time; confounding educational level with staffing level only makes the data unreliable.
    anniv91106, klone, and Esme12 like this.
  9. Visit  WanderingSagehen} profile page
    0
    Maybe those nurses holding bsn degrees care more about the nursing field and have better outcomes not because of the degree but their general increased interest in the field.
  10. Visit  hope3456} profile page
    3
    Quote from WanderingSagehen
    Maybe those nurses holding bsn degrees care more about the nursing field and have better outcomes not because of the degree but their general increased interest in the field.
    Another theory is that BSN nurses get hired by the "better" facilities with "better" doctors, supplies, support systems, ect. That enable them to give better care and in turn, better outcomes.
  11. Visit  BostonFNP} profile page
    2
    Quote from TriciaJ
    This study is not new. The BSNs got a shorter load and the ADNs got a heavier load. Which patients did better? What do we naturally conclude? That you can't measure 2 simultaneous variables without a corollary study. Puh-lease! (Unless this is some other study and all the variables were measured separately. Does it say that somewhere?)
    Did you even read the paper or did you just react immediately stating it was flawed?
    macawake and wtbcrna like this.
  12. Visit  MunoRN} profile page
    3
    Quote from BostonFNP
    Did you even read the paper or did you just react immediately stating it was flawed?
    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.
    Not_A_Hat_Person, TriciaJ, and hope3456 like this.
  13. Visit  Charlie Don't Surf} profile page
    1
    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.
    Well said-
    TriciaJ likes this.
  14. Visit  BostonFNP} profile page
    1
    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
    macawake likes this.
  15. Visit  BostonFNP} profile page
    0
    To clarify for those people that don't have access, from the author's interpretation statement:

    "Findings of our analysis of 300 hospitals in nine countries show that an increase in nurses' workloads by one patient increases the likelihood of inpatient hospital mortality by 7%, and a 10% increase in bachelor's degree nurses is associated with a decrease in odds on mortality by 7%. These findings emphasize the risk to patients that could emerge in response to nurse staffing cuts and suggest that an increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths."


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