The Impact of Nurses on Patient Morbidity and Mortality - the Need for a Policy Change in Response to the Nursing Shortage

Article excerpt

Abstract

Context. Workforce projections indicate that by 2012 there will be a shortfall of 61 000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes.

Purpose. This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes.

Method. An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken.

Findings. Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3-12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a costeffective investment for the health system but this is not fully appreciated by health policy advisors.

Conclusions. An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety.

What is known about the topic? Projections indicate that by 2012 there will be an estimated shortfall of 61 000 registered nurses in Australia. However, research demonstrates the number of registered nurses caring for patients is critically important to prevent adverse patient outcomes. Evidence also confirms that improvements in nurse staffing is a cost-effective investment for the health system.

What this paper adds? The paper exposes the lack of an appropriate policy response to the evidence in regard to nurse staffing and patient outcomes. It argues that patient safety must be recognised as a shared responsibility between policy makers and the nursing profession.

What are the implications for practitioners? Policy makers, health departments, Chief Executives and Nurse Leaders need to ensure that adequate nurse staffing includes a high proportion of registered nurses to prevent adverse patient outcomes.

Introduction

By 2012 there will be an estimated shortfall of 61 000 registered nurses (RNs) in Australia.1 One response to this has been an exploration of alternative skill mix models.2 Many healthcare agencies (acute, community and aged care facilities) have changed the mix of nurses, hiring more enrolled nurses and unregulated workers (assistants in nursing or healthcare assistants) and less RNs. However, these initiatives conflict with the growing body of evidence that links the role of RNs to patient outcomes, referred to as 'nursing sensitive outcomes'.3 This paper will review the literature in regard to the relationship between the number and mix of nurses and patient outcomes including mortality. Further, the review will establish the affordability of increases in the RN workforce and discuss the lack of understanding of this critical evidence by executives and doctors. Lastly, using the outcomes of the review the authors will expose a lack of a collective policy response in Australia to the evidence in the literature.

Method

For the literature review an electronic search was undertaken of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline dated from 1982 to 2005. A search for works by prominent authors in the field was also undertaken. The listed search terms from these publications also assisted in establishing search terms. Search terms included outcomes (healthcare), hospital mortality, personnel staffing, skill mix, nurse-patient ratio, workload, workload measurement, educational status, practice environment, patient classification methods and patient dependency. …