16 Nov Substituting Less Well Trained Assistants For Nurses Increased Hospital Mortality
MedicalResearch.com Interview with:
Dr Linda H Aiken
Dr Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing
Professor of Sociology, School of Arts & Sciences
Director, Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
Center for Health Outcomes and Policy Research
Philadelphia, PA 19104
MedicalResearch.com: What is the background for this study?
Response: The idea that adding lower skilled and lower wage caregivers to hospitals instead of increasing the number of professional nurses could save money without adversely affecting care outcomes is intuitively appealing to mangers and policymakers but evidence is lacking on whether this strategy is safe or saves money.
MedicalResearch.com: WhatWhat are the main findings?
Response: In the largest study to date carried out in 6 European countries, we found that that substituting one nurse assistant for a professional nurse for every 25 patients increased mortality by 21%. Other key indicators of poor quality care were also evident including increased proportions of patients giving low ratings to their hospitals, lower nurse ratings of quality and safety of care, and increased frequency of adverse and costly patient outcomes such as infections and falls.
MedicalResearch.com: What should readers take away from your report?
Response: The intuitive appeal of substituting lower trained assistants for nurses in hospitals is not supported by rigorous research. The higher the proportion of professional nurses in hospitals, the better the outcomes for patients. There is no cost savings either because of the significant increase in costly adverse patient outcomes associated with having a higher proportion of nurse assistants. Additionally, nurse job dissatisfaction and burnout increases with more nurse assistants adding additional costs from higher nurse turnover. Reducing the hospital nursing skill mix is not in the interest of patients and does not save money for hospitals. Policies like that of the National Health Service in England to introduce a new category of worker—the nursing associate—rather than improving professional nurse staffing risks further erosions in quality and safety of hospital care.
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Citation:
Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care
Linda H Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel,Matthew McHugh, Claudia B Maier, Teresa Moreno-Casbas, Jane E Ball,Dietmar Ausserhofer, Walter Sermeus, For the RN4CAST Consortium
BMJ Qual Saf bmjqs-2016-00556
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Last Updated on November 16, 2016 by Marie Benz MD FAAD