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Main Title: Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care
Author(s): Aiken, Linda H.
Sloane, Douglas
Griffiths, Peter
Rafferty, Anne Marie
Bruyneel, Luk
McHugh, Matthew
Maier, Claudia B.
Moreno-Casbas, Teresa
Ball, Jane E.
Ausserhofer, Dietmar
Sermeus, Walter
Type: Article
Language Code: en
Abstract: Objectives: To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design: Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting: Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results: Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. Conclusions: A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.
Issue Date: 2016
Date Available: 9-Aug-2018
DDC Class: 610 Medizin und Gesundheit
Subject(s): health care
quality of care
patient safety
Sponsor/Funder: EC/FP7/223468/EU/Nurse Forecasting: Human Resources Planning in Nursing/RN4Cast
Journal Title: BMJ quality & safety
Publisher: BMJ Publishing Group
Publisher Place: London
Volume: 26
Issue: 7
Publisher DOI: 10.1136/bmjqs-2016-005567
Page Start: 559
Page End: 568
EISSN: 2044-5423
ISSN: 2044-5415
Appears in Collections:FG Management im Gesundheitswesen » Publications

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