Wednesday 16 November 2016

Patients one fifth more likely to die in hospitals with less qualified nurses


NHS plans to give nursing tasks to cheaper assistants are a "risky experiment," researchers have warned - after a study found patients could be a fifth more likely to die in such circumstances.

Ministers have announced 2,000 nursing associate roles across England, with the first 1,000 due to start training from next month.

Controversially, they will be given jobs currently only done by registered nurses, including administering controlled drugs and carrying out some invasive procedures.

<>The new research suggests that diluting the skill mix - especially in England, which already has one of the lowest ratios of qualified nurses to other staff - could put lives at risk.

Researchers tracked almost 300,000 patients from 32 NHS hospital trusts in England, as well as hospitals in Belgium, Finland, Ireland, Spain and Switzerland. For every 25 patients, substituting just one qualified nurse for a lower-qualified member of staff was associated with a 21 per cent rise in the odds of dying.

This was in hospitals with an average staffing levels, made up of 66 per cent qualified nurses, to other staff. In England the average is lower, at 57 per cent, falling as low as 47 per cent in some hospitals, the study, published in the journal BMJ Quality & Safety, found.

The new study, involving King's College London and the University of Southampton, found patients were more likely to die and suffered worse quality of care if qualified staff were replaced by lower-skilled assistants.

The research involved survey responses for just over 13,000 nurses in 243 hospitals and almost 19,000 patients in 182 of these hospitals. Experts also looked at discharge data in 188 hospitals for more than 275,500 patients who had undergone surgery. They also examined staffing ratios on a shift.

The total nursing staff: patient ratio was six for every 25 patients, but ranged from around 2.5 to around 14. The average percentage of professional nurses ranged from 41 per cent to 87 per cent.

The research found that patients looked after in hospitals with a higher proportion of nurses suffered fewer bedsores, falls, and urinary infections - often markers of poor care - and rated their care more highly.

Nurses in these hospitals reported fewer issues with patient safety, had less burnout and job dissatisfaction and were less likely to report an "inadequate safety culture".

The results found that for every 10 per cent rise in the proportion of professionally qualified nurses, there was an 11 per cent fall in the odds of a patient dying after surgery, a 10 per cent fall in the odds of patient dissatisfaction, and an 11 per cent fall in the odds of reporting poor quality care.



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