Lack of nurses linked to missed care and higher patient mortality

May 5, 2017, Karolinska Institutet

There is a clear correlation between the number of registered nurses working at an acute hospital, the amount of nursing care that is left undone and the number of patients who die, a new thesis from Karolinska Institutet in Sweden shows. Moreover, the higher death rate associated with low nurse staffing levels does not decline if the nurses are replaced by support workers.

Research conducted since the 1980s has established an inverse correlation between staffing levels and the rate of patient deaths at acute hospitals, but no studies have yet been done to show what it is attributable to or whether there is a causal relationship. In her thesis from Karolinska Institutet, Jane Ball has interrogated the relationship between nurse staffing levels, missed care and risk of patient death in over 300 acute hospitals in nine European countries, including Sweden and the UK.

10 per cent missed care linked to a 16 per cent higher risk of death

Nurses were asked to answer a questionnaire on how much and what type of care they did not provide owing to lack of time during their latest . These responses were then related to reports of nurse staffing during the same work shift. The results show a clear correlation between fewer nurses, more missed care and higher patient mortality. In who had undergone common, non-life threatening surgical procedures, 10 per cent missed care was linked to a 16 per cent higher risk of death within 30 days of surgery.

"We found a significant association between mortality rates and the volume of missed care owing to lack of nursing time, which supports the inference of a causal connection between registered nurse staffing and patient mortality," says Jane Ball, registered nurse, doctoral student at Karolinska Institutet's Department of Learning, Informatics, Management and Ethics (LIME) and researcher at University of Southampton, England.

In Sweden, 74 per cent of the surveyed nurses reported that they had left necessary care undone due to lack of time; in the UK the corresponding figure was 86 per cent. Ms Ball's thesis also shows that low levels of registered nurse staffing cannot be compensated for by other healthcare staff – the volume of omitted necessary care remains unchanged.

The problem deserves more attention

"What surprised me most while working on my thesis is that staffing levels differ a great deal between different departments and hospitals," says Ms Ball. "It also surprises me that even more attention isn't given to low nurse staffing levels given that short-staffing jeopardises patient safety and put lives at risk."

Ms Ball will now go on to analyse the correlation further with the help of electronic data instead of questionnaires, and examine in more detail the role of patient surveillance on patient survival.

On 5 May 2017 Jane Ball defends her thesis "Nurse staffing levels, care left undone & patient mortality in acute hospitals" at Karolinska Institutet.

Explore further: Higher nurse to patient ratio linked to reduced risk of inpatient death

More information: Nurse staffing, care left undone and patient mortality in acute hospitals: openarchive.ki.se/xmlui/handle/10616/45563

Related Stories

Higher nurse to patient ratio linked to reduced risk of inpatient death

February 9, 2016
A higher nurse to patient ratio is linked to a reduced risk of inpatient death, finds a study of staffing levels in NHS hospitals, published in the online journal BMJ Open.

Most ward nurses say time pressures force them to 'ration' care

July 29, 2013
Most ward nurses say they are forced to ration care, and not do or complete certain aspects of it—including adequate monitoring of patients—because they don't have enough time, indicates research published online in BMJ ...

California nurse staffing

July 15, 2011
In a comprehensive analysis comparing nurse staffing in California hospitals to similar hospitals in the U.S. over nearly a decade, researchers at the University of Pennsylvania School of Nursing have found that controversial ...

Employment of more nurse assistants is associated with more deaths and lower quality care

November 16, 2016
Hospitals that employ more nurse assistants relative to the number of professionally qualified nurses have higher mortality rates, lower patient satisfaction, and poorer quality and safety of care, according to a new European ...

Study takes a step back to look at use of restraints in hospitals

August 24, 2016
The use of belts, bedrails and other devices to prevent patients from hurting themselves has increasingly come under fire. Within a hospital setting, the use of such restraints may be reduced by ensuring that the nursing ...

Study to investigate nurse staffing levels and safe care

July 29, 2015
A University of Southampton study will investigate how the provision of nurses in hospitals affects the care and safety of patients.

Recommended for you

India launches 'Modicare', world's biggest health scheme

September 23, 2018
India on Sunday launched the world's biggest health insurance scheme which Prime Minister Narendra Modi said would cover some 500 million poor people.

Patient-centered visual aid helps physicians discuss risks, treatments with parents

September 21, 2018
A series of illustrations and charts designed as decision aids for parents of children with minor head injuries helped them communicate with emergency medicine physicians and make informed decisions about their child's care, ...

Alcohol responsible for one in 20 deaths worldwide: WHO

September 21, 2018
Alcohol kills three million people worldwide each year—more than AIDS, violence and road accidents combined, the World Health Organization said Friday, adding that men are particularly at risk.

Smart pills dumb down medical care, experts warn

September 21, 2018
Enthusiasm for an emerging digital health tool, the smart pill, is on the rise but researchers at the University of Illinois at Chicago have published a paper in the American Journal of Bioethics that cautions health care ...

Crunched for time? High-intensity exercise = same cell benefits in fewer minutes

September 20, 2018
A few minutes of high-intensity interval or sprinting exercise may be as effective as much longer exercise sessions in spurring beneficial improvements in mitochondrial function, according to new research. The small study ...

China's doctor shortage prompts rush for AI health care

September 20, 2018
Qu Jianguo, 64, had a futuristic medical visit in Shanghai as he put his wrist through an automated pulse-taking machine and received the result within two minutes on a mobile phone—without a doctor present.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.