Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

BMJ Quality and Safety - Tập 26 Số 7 - Trang 559-568 - 2017
Linda H. Aiken1, Douglas M. Sloane2, Peter Griffiths3, Anne Matthews4, Luk Bruyneel5, Matthew D. McHugh2, Claudia B. Maier6, Teresa Moreno‐Casbas7, Jane Ball3, Dietmar Ausserhofer8, Walter Sermeus5
1University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, 418 Curie Boulevard, Philadelphia, PA 19104, USA
2University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania, USA
3Faculty of Health Sciences, University of Southampton, Southampton, UK
4King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK
5University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
6Department of Healthcare Management, Technische Universitat Berlin, Berlin, Germany
7Investén-Isciii. Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
8Universitat Basel Department Public Health, Institute of Nursing Science, Basel, BS, Switzerland

Tóm tắt

ObjectivesTo determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.DesignCross-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.SettingAdult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.ParticipantsSurvey 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 measuresPatient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction.ResultsRicher 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.ConclusionsA 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.

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BMJ Quality and Safety

Tập 26 Số 7

559-568

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