Hospital death rates rise if fewer nurses are on wards, says new research

Research suggests the drive to replaces nurses with less qualified staff should be reviewed

Death rates are higher on wards with fewer nurses, according to research that suggests the drive to replaces nurses with less qualified staff should be reviewed.

Experts studied 137 acute hospital trusts in England and found lower death rates when there were more nurses working. However, hospitals with healthcare support workers in higher numbers had patient death rates seven per cent higher.

Of the 31 trusts where the team knew the exact staffing ratio per patient, the researchers found that those with an average of six patients or fewer per registered nurse had 20 per cent lower death rates compared to trusts with more than 10 patients per nurse. 

The findings, published in BMJ Open, also show a slight increase in patient deaths for trusts with the most healthcare support workers.

Lead researcher Jane Ball, from the University of Southampton, said: “At best, healthcare support workers make no difference, but at worst a higher level of support workers is linked to an increased risk of death during a hospital stay. 

“The heavy reliance on support workers at the expense of registered nurses puts patient safety at risk. That’s a situation that can lead to more patients dying during their hospital stay.” 

She said that introducing new roles - such as the nursing associate role announced by the Government in December - must be evaluated for their effect on patient safety.

Janet Davies, Chief Executive of the Royal College of Nurses, said: “The evidence is a clear warning about the impact on patient care and outcomes if we are to have too few registered nurses or are substituting them for healthcare support workers [who] are highly valuable staff but they need to complement the registered nursing workforce - not replace it.” 

A separate study, published in the Archives of Disease in Childhood journal, found that a drop in the number of nurses caring for poorly babies is leading to higher death rates. 

One-to-one nursing for very sick babies in neonatal intensive care dropped by a third - from an average of nine per cent intensive care days to an average of around six per cent - between 2008 and 2012.

A 10 per cent drop in the proportion of intensive care days on which one-to-one nursing care was provided was linked with a monthly increase in baby death rates of 0.6 per 100 infants in intensive care. 

The authors stressed the study was observational and did not prove that low nursing ratios were to blame, but they said it suggested decreases in intensive care nursing “increase the in-hospital mortality rate”. 

Caroline Davey, the chief executive of premature and sick baby charity Bliss, said: “The Government and NHS decision makers have so far failed to take the necessary action to address these staffing shortfalls, which we have known about for many years.”