Shortage = death

Shortage = death

October 23, 2006 -- Today the BBC web site posted a generally good piece about a large new study of English hospitals that links lower nurse staffing to higher patient mortality. "Nurse shortage boosts death rates" reports that patient mortality at hospitals with the worst nurse staffing levels was 26% higher than at hospitals "with more nurses per patient." The study was published in the International Journal of Nursing Studies, and it is part of the five-nation International Hospital Outcomes Study. The piece quotes lead researcher Anne Marie Rafferty (though it could have given more detail about this nursing leader), as well as Royal College of Nursing general secretary Beverly Malone. Malone argues that the study shows that cutting nursing posts is dangerous "short-termism."

The piece reports that the U.K. researchers examined almost 120,000 patient records and data from 4,000 nurses at 30 hospital trusts, which had patient-to-nurse ratios ranging from 6.9 to 14.3. The data was drawn from 1989-90 (Professor Rafferty explains that this delay was due to the "length of time taken to design how the study should be carried out"). The piece notes that the other nations participating in the International Hospital Outcomes Study are Scotland, Germany, Canada, and the United States, and that these findings "closely mirror" recent findings of the study's Canadian and U.S. components.

The article says that "patients in the hospitals where nurses had the highest workloads were more likely to suffer complications and/or die than those in hospitals with better staffing ratios." It also reports that nurses with the highest patient loads "were 71% more likely to suffer 'burn out,' and 91% more likely to be unsatisfied with their jobs compared with the nurses with a lighter workload." The piece could have been more precise in explaining just what is being compared--what does "a lighter workload" mean? And "better staffing ratios?" The piece might also have spent a little more time on the burnout issue, which is itself a significant factor in the shortage. Fewer nurses means more burnout, which means fewer nurses.

In any case, the piece has some good quotes. Professor Rafferty, identified as "lead researcher on the study and a health services researcher from Kings College London," says the study authors calculate that "some 246 fewer deaths would have occurred in these 30 trusts had all the patients been treated in hospitals with the most favourable staffing levels." She notes that that means "thousands" more could be saved each year through "investments in nursing" at National Health Service (NHS) hospitals.

In any case, the piece has some good quotes. Professor Rafferty reportedly says the study authors calculate that "some 246 fewer deaths would have occurred in these 30 trusts had all the patients been treated in hospitals with the most favourable staffing levels." She also notes that that means "thousands" more could be saved each year through "investments in nursing" at National Health Service (NHS) hospitals. Dr. Rafferty is identified as "lead researcher on the study and a health services researcher from Kings College London." But she is not identified as a nurse, much less one with a doctorate. In fact, she is an eminent scholar and apparently the first nurse to obtain a doctorate from Oxford.

The piece gives significant space to RCN leader Beverly Malone (who is identified as "Dr"). Malone does a good job of linking the results to her union's advocacy agenda:

This new independent research backs up what nurses have always known: that nurse numbers really do matter and that nurses make a life and death difference to how well their patients recover. That is why we must not allow nursing posts to be sacrificed to ease financial deficits. This is short-termism in the extreme and will end up costing the health service more in the long run as patients with complications that should have been picked up in the first place are re-admitted.

Echoing these concerns, Liberal Democrat health spokesman Steve Webb says the study shows "the damage that will be done to patient care if the NHS financial crisis results in even more frontline staff cuts."

In response, an unnamed Department of Health spokeswoman notes that NHS now has 89,000 more nurses than it did in 1997. She also states that "[n]ursing ratios are a complex subject which has yet to gain a definitive consensus within the nursing profession and we welcome this addition to this debate." Of course, the 89,000 nurse figure has little meaning without corresponding data as to how the patient population and other relevant factors have changed in the last nine years. And the comment about the ratios issue being "complex" and lacking in "definitive consensus" does nothing to challenge the findings of the study.

We thank the BBC for this generally helpful piece.

See "Nurse shortage boosts death rates; Nursing shortages are linked to an
increase in patient death rates, a study of English hospitals has found,"
posted on the BBC website on October 23, 2006.

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