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  • Research points to patient safety in nurse numbers

    Author: Karen Keast

International research shows nurse staffing levels contribute to a seven-fold difference in patient mortality rates between hospitals.

Patient safety researcher Dr Linda Aiken, a keynote speaker at today’s Queensland Nurses’ Union’s Keeping Patients Safe symposium, said her research shows nurse levels and skills mix has a significant impact on patient survival rates, hospital inquired infections and falls.

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“One of the important things that’s not well understood by nurses or the public or policy-makers is within every country there’s tremendous difference in patient outcomes across hospitals and in their staffing,” she said.

“Even in countries that report they have ratios, we find that there is tremendous variation in the actual operationalisation of those ratios, so this is why we find a relationship between difference in mortality and differences in nurse staffing.”

Dr Aiken, director of the United States’ Centre for Health Outcomes and Policy Research, said while a seven-fold difference exists in mortality rates between hospitals, her research spanning 30 countries also shows a 12-fold difference in mortality rates after common surgery between hospitals.


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“I don’t think there’s an overall awareness among nurses or the public or policy-makers that there’s that much difference in outcomes from something simple like general surgery,” she said.

“We find that a major reason for these big differences in mortality really has to do with the differences in staffing across these hospitals.

“The hospitals with higher nurse ratios and skill levels repeatedly out-perform other hospitals.”

Dr Aiken said California implemented mandated ratios in 2004, resulting in mortality rates that are among the lowest in the US for hospital patients after surgery.

“We estimated that if my state of Pennsylvania, which does not have this legislation, staffed at the same levels that Californian hospitals are required to staff at, we would prevent 2000 deaths a year in our state.”

Dr Aiken, who is also a Professor of Nursing at the University of Pennsylvania, said she planned to meet with nurse leaders in Australia to discuss the possibility of an Australian study investigating the impact of nursing on patient outcomes.

“We’ve had a very big impact in the 30 countries where we have done this research,” she said.

“It led to the state of California adopting mandatory patient to nurse staffing ratios.

“Our study has led to federal pending legislation that will require all hospitals in the country to report their staffing levels on a publicly available website.

“In the UK, their own quality organisation within the National Health Service, on the basis of our research, has recommended patient to nurse ratios.

“It leads to very actionable changes in practice and policy.”

Dr Aiken said research was vital to instigate change in nurse staffing levels in Australian hospitals.

“Nurses immediately are supportive of this kind of work in every country where we’ve been because they already know from their own practice that nurses and the number of nurses at the bedside are very important for patient outcomes,” she said.

“But they want to be able to demonstrate through scientific data on a large scale to people that might be more skeptical, namely policy-makers and other managers.”

QNU secretary Beth Mohle said a lack of nurse to patient ratios in Queensland was putting patients at risk.

“Most Queenslanders would be unaware there are currently no rules in place to govern how many patients can be allocated to a single nurse,” she said.


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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords