BMJ Quality & Safety published a study finding acute care hospitals in Europe that substituted nursing assistants for professional nurses resulted in poorer quality of care and higher patient mortality, according to Medscape.
In the study, researchers evaluated the impact of increasing the number of less extensively trained nurses at 243 acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.
Researchers surveyed 13,077 nurses and 18,828 patients who were present in 182 hospitals between 2009 and 2010. Then, investigators assessed mortality records for 275,519 surgical patients who underwent procedures in 188 of the 243 hospitals between 2007 and 2009.
The mean nurse skill mix was nearly 66 percent. Study researchers defined the mean nurse skill mix as "the number of professional nurses divided by the number of direct care nursing workers of any qualification level during each professional nurse's most recent shift."
Here are six highlights:
1. Researchers noted the average hospital mortality rate was 12.9 per 1,000 discharges during the study period. The average total nurse staff-to-patient ratio was 6.1 nurses for every 25 patients.
2. Of the hospitals with average nurse staffing levels and skill mix, researchers estimated that replacing one professional nurse with a lower-skilled employee, like an assistant, would increase a patient's mortality odds by 21 percent.
3. Researchers also estimated that every 10 percent increase in the number of nurses with high-level skills was linked with an 11 percent decease in a patient's odd of dying postoperatively and a 10 percent decrease in the odds of a patient giving a hospital a low rating.
4. Of the 103 patients completing surveys in each hospital, 54 percent, on average, gave their hospital a low rate.
5. Thirty-one percent of nurses reported job dissatisfaction and 30 percent reported burnout.
6. Study limitations included the study's observational nature, cross-sectional design and the focus on a single time.
"We find a nursing skill mix in hospitals with a higher proportion of professional nurses is associated with significantly lower mortality, higher patient ratings of their care and fewer adverse care outcomes," the researchers concluded.