Date Published: 24 October 2006

Independent UK research proves link between nurse numbers and patient mortality

Thousands of lives could be saved every year in UK's National Health Service (NHS) by increasing the number of nurses

Patients staying in hospitals where there are fewer nurses on the wards are more likely to die or experience complications, according to a major new study launched at the Royal College of Nursing (RCN). The independent study – the first of its kind in the UK – mirrors the findings of US research by establishing a direct link between the number of nurses working on wards and patients' chances of recovery and survival. The research also finds that nurses working on wards where nurse to patient ratio are lower are much more likely to experience “burn out.”

For her research Professor Anne Marie Rafferty surveyed nearly four thousand nurses and looked at 118,752 patient episodes of care in 30 hospital trusts in England. She found that wards with lower nurse to patient ratios had a 26% higher patient mortality rate. Professor Rafferty concluded that had there been more nurses on the wards, 246 lives could have been saved.

Prof Rafferty's other major finding is that nurses in the hospitals with the heaviest workloads are between 71% and 92% more likely to experience burn out and become dissatisfied with their jobs. They are also more likely to report low or deteriorating quality of care on their wards and hospitals. Conversely, hospitals where the number of nurses per patient are greatest, experience significantly lower surgical mortality rates.

Prof Rafferty said:

We calculate that some 246 fewer deaths would have occurred in these 30 trusts had all the patients been treated in hospitals with the most favourable staffing levels. The number of lives that could potentially be saved through investments in nursing throughout NHS hospitals could be thousands every year.

RCN General Secretary Dr Beverly Malone said:

This new independent research backs up what nurses have always known: that nurse numbers really do matter and that nurses make a life and death difference to how well their patients recover.

_ That is why we must not allow nursing posts to be sacrificed to ease financial deficits. This is short-termism in the extreme and will end up costing the health service more in the long run as patients with complications that should have been picked up in the first place are re-admitted. It is vital we ensure we have the right numbers of nurses and skills mix on hospital wards if we are to give patients the best chance of recovery.

Prof Rafferty's research endorses an independent review by the London School of Hygiene and Tropical Medicine of the impact of registered nurses on patient outcomes. The review, commissioned by the RCN in 2004, concluded higher numbers of registered nurses and a higher proportion of registered nurses in the nursing workforce help reduce patient mortality, infection rates, patient falls, the incidence of pressure sores and mistakes administering medication.

Last month the RCN set a benchmark outlining nursing skill mix levels for general wards in NHS hospitals for the first time. The RCN recommends a skill mix ratio of 65% registered nurses to 35% health care assistants for the general ward establishment.

Prof Rafferty's research is being launched at the RCN's London headquarters on Monday 23rd October. Professor Linda Aiken of University of Pennsylvania will outline the results of similar research in the USA. RCN General Secretary Dr Beverly Malone and Chief Nursing Officer Christine Beasley will also be speaking at the launch.

Source: Royal College of Nursing (RCN), UK.
For more information see http://www.rcn.org.uk.

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