Lower levels of registered nurses and a greater use of nursing assistants are associated with an increased risk of death during an admission to hospital, according to a new study.
The paper, published in BMJ Quality and Safety, highlights the possible consequences of reductions in qualified nurse staffing, experienced in recent years in the UK, while demonstrating that policies encouraging the increased use of nursing assistants to compensate for shortages of nurses might be putting lives at risk.
The researchers, including Professor Jim Briggs, of the University of Portsmouth’s School of Computing, say this was an observational study, and as such, can’t establish cause, though the findings are broadly in line with previous research.
At a time when the NHS is facing increasing difficulties in recruiting and retaining staff, this research reveals the potential consequences of shortages of registered nurses in terms of the negative impact on patient safety. Assistant staff are an important part of the team but adding more of them is not the solution.
Lead author, Professor Peter Griffiths, chair of health services research and head of the Health Work research group at the University of Southampton, said this study – the first to look at the effects of nursing assistants in the workforce – and its findings will have significant implications, particularly for hospitals which see adding assistants as a means of making up for nursing shortages.
He said: “At a time when the NHS is facing increasing difficulties in recruiting and retaining staff, this research reveals the potential consequences of shortages of registered nurses in terms of the negative impact on patient safety.
“Assistant staff are an important part of the team but adding more of them is not the solution.”
The study, Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal observational study, involved the Universities of Southampton, Portsmouth and York and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Wessex and funded by the NIHR. The team examined three years of hospital data from 32 wards across a large English hospital, covering almost 140,000 patients who were admitted to general hospital wards between 1 April 2012 and 31 March 2015.
The risk of death went up when nursing assistant staffing was low but it also increased when it went above the typical level for a ward. We are not sure why that happened but we think it is because there are not enough trained nurses to supervise the assistants and assistants don’t have the skills to recognise and act when a patient starts to deteriorate.
The findings show that for every hour less of nursing care per patient over the first five days of a hospital stay, the risk of a patient dying was increased by three per cent. High numbers of admissions per nurse also increased the risk of death significantly, while adding nursing assistants above current levels seemed to increase rather than decrease the risk.
Professor Griffiths said: “Nursing care assistants do have an important part to play in maintaining the safety of hospital wards but they cannot act as substitutes for registered nurses.
There is a lot more still to be learned about the effectiveness of resource allocation in the NHS. Combining workforce and patient data to perform this sort of important analysis is the future of much healthcare research.
“The risk of death went up when nursing assistant staffing was low but it also increased when it went above the typical level for a ward. We are not sure why that happened but we think it is because there are not enough trained nurses to supervise the assistants and assistants don’t have the skills to recognise and act when a patient starts to deteriorate.
Professor Jim Briggs, Director of the Centre for Healthcare Modelling and Informatics at the University of Portsmouth and a co-investigator, was positive about the contribution of data analysis to the project.
He said: “There is a lot more still to be learned about the effectiveness of resource allocation in the NHS. Combining workforce and patient data to perform this sort of important analysis is the future of much healthcare research.”
This study shows us how important it is to have properly qualified nurses working on wards and registered nurses and care assistants should not be treated as equivalent. We need to improve the supply of registered nurses because shortages can cause great harm to patients and we can’t fix it by increasing the numbers of lesser trained nursing staff in the workforce.
Consultant Physician and co-investigator, Dr Paul Schmidt said: “This study shows us how important it is to have properly qualified nurses working on wards and registered nurses and care assistants should not be treated as equivalent. We need to improve the supply of registered nurses because shortages can cause great harm to patients and we can’t fix it by increasing the numbers of lesser trained nursing staff in the workforce.”