Reducing nurse ratios may be a ‘fatal’ error

Europe-wide study finds link between nurse-to-patient ratios and patient deaths

For every 10 per cent increase in nurses who have attained a bachelor’s degree, there is an associated 7 per cent decline in mortality, according to study
For every 10 per cent increase in nurses who have attained a bachelor’s degree, there is an associated 7 per cent decline in mortality, according to study

Patient-to-nurse ratios and the level of a nurse’s education directly affect the number of deaths after routine surgery, a major study published this morning suggests.

The study of almost half a million patients from nine European countries, including the Republic of Ireland, found that every one-patient increase in patient-to-nurse ratios is associated with a 7 per cent increase in deaths following surgery. And for every 10 per cent increase in nurses who have attained a bachelor's degree, there is an associated 7 per cent decline in mortality.

The Irish Times understands that a survey to be published by the Irish Nurses and Midwives Organisation (INMO) in the coming weeks will show that no ward in an Irish hospital has a nurse looking after fewer than six patients, with some nurses on night duty responsible for up to twice this number.

Liam Doran of the INMO welcomed today's research. Pointing to a 13.5 per cent decrease in the number of nurses employed here in the last five years, he said "it is false economy to attack the nursing numbers in this country".

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“Having one nurse to four patients during the busy part of the day on a ward optimises the outcome for patients,” he said.

Today’s study shows that patients in hospitals in which 30 per cent of nurses had degrees and cared for an average of eight patients each had a higher risk of death following inpatient surgical procedures.

The Irish arm of the RN4CAST study, published in The Lancet today, was carried out by a team from Dublin City University led by Prof Anne Scott.

“Our results suggest that the assumption that hospital nurse staffing can be reduced to save money without adversely affecting patient outcomes may be misguided at best, and fatal at worst,” she said. “This is crucial information for hospital managers given the significant reduction in nurse staffing in Irish hospitals since 2008, and particularly in light of the ongoing moratorium on staffing.”

In Europe, the proportion of hospital nurses with bachelor's degrees varies significantly across countries. Ireland has moved to an all-graduate nursing profession; the first national, registration group of nurses graduated with a BSc in nursing in 2006.

However, there is still considerable variation, within hospitals and between hospitals, in the percentages of nurses with degree-level education.

Muiris Houston

Dr Muiris Houston

Dr Muiris Houston is medical journalist, health analyst and Irish Times contributor