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Wednesday, 05 December 2018

Chances of dying in hospital increases when nurses replaced with nursing assistants, new study

Written by Ben Mitchell

The risk of dying in hospital increases when nurses are replaced with nursing assistants, according to a new study.

The research authors from the University of Southampton suggest that policies encouraging the increased use of nursing assistants to compensate for shortages of registered nurses (RN) may be putting lives at risk.

Professor Peter Griffiths, chairman of health services research and head of the health work research group at the University of Southampton, said: "At a time when the NHS is facing increasing difficulties in recruiting and retaining staff, this research reveals the potential consequences of shortages of registered nurses in terms of the negative impact on patient safety.

"Assistant staff are an important part of the team but adding more of them is not the solution."

The research team for the study, published in BMJ Quality and Safety, examined three years of hospital data from 32 wards across a large English hospital, covering almost 140,000 patients who were admitted to general hospital wards between April 1 2012 and March 31 2015.

A University of Southampton spokesman said: "The findings show that for every hour less of nursing care per patient over the first five days of a hospital stay, the risk of a patient dying was increased by 3%.

"High numbers of admissions per nurse also increased the risk of death significantly, whilst adding nursing assistants above current levels seemed to increase rather than decrease the risk."

Prof Griffiths (pictured) said that although the research was an observational study which did not prove cause, it did reaffirm findings from other studies.

He said: "Nursing care assistants do have an important part to play in maintaining the safety of hospital wards but they cannot act as substitutes for registered nurses.

"The risk of death went up when nursing assistant staffing was low but it also increased when it went above the typical level for a ward.

"We are not sure why that happened but we think it is because there are not enough trained nurses to supervise the assistants and assistants don't have the skills to recognise and act when a patient starts to deteriorate."

Consultant physician and co-investigator Dr Paul Schmidt said: "This study shows us how important it is to have properly qualified nurses working on wards and registered nurses and care assistants should not be treated as equivalent.

"We need to improve the supply of registered nurses because RN shortages can cause great harm to patients, and we can't fix it by increasing the numbers of lesser trained nursing staff in the workforce."

Dame Donna Kinnair, Royal College of Nursing acting chief executive and general secretary, said: "As the official count of vacant nurse jobs rises this year, this study shows the death count will too, it's as stark as that.

"The Government and the NHS in England must pull together to resolve the staffing crisis, patients are paying the highest price for the shortage of nurses.

"This research is the latest in a long line of studies showing that patient safety is at risk from the failure to plan for a long-term workforce.

"Asking nursing students to take on thousands of pounds worth of debt to fund their courses has led to a dramatic fall in the number of students applying for university nursing degrees, so the RCN is calling for at least £1 billion to be invested into nursing higher education.

"This investment needs to go hand in hand with a law that enshrines safe staffing, and ensures we have the right number of nurses, with the right knowledge, in the right place.

"We need accountability at all levels for nurse staffing to keep the public safe."

The study, Nurse Staffing Nursing Assistants And Hospital Mortality: Retrospective Longitudinal Observational Study, involved the Universities of Southampton, Portsmouth and York and the National Institute for Health Research (NIHR), which funded the research.

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