Death rates rise when hospitals replace RNs with assistants


The odds of a patient dying in a hospital increase dramatically when organizations replace professionally qualified nurses with lower skilled nursing assistants, according to a large European study.

For every 25 patients, just one professional nurse substitution was associated with a 21 percent rise in the odds a patient will die in a hospital with average nurse staffing levels and skill mix, finds a new study published online in BMJ Quality & Safety.

The findings raise concerns as financial pressures, healthcare reforms and nursing staff shortages often force hospitals to reconsider their nursing skill mix, the research notes.

Researchers analyzed the association between nursing skill mix and the risk of patient death, patients' views of their care, and other quality of care indicators, such as the prevalence of falls and bedsores, in acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. They based their findings on survey responses from more than 13,000 nurses in 243 hospitals and nearly 19,000 patients in 182 of these hospitals.

The survey found that in hospitals, a higher proportion of professionally qualified nurses was associated with a significantly lower risk of death, higher levels of patient satisfaction, and fewer reported indicators of poor quality care such as bedsores, falls and urinary infections. In addition, nurses were more satisfied with their jobs and less likely to experience burnout.

The findings, researchers say, suggest that hospital leaders should be cautious when implementing policies to reduce hospital nursing skill mix. The consequences, they said, can be life-threatening for patients.