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Substituting nurse aides for registered nurses can raise workload and affect safety

Nurse staffing models that substitute nursing aides for registered nurses can have a negative effect on patient safety and quality of care, say Taiwanese researchers.

They carried out a three-phase study in a 20-bed respiratory care centre in southern Taiwan, in which each phase lasted 11 months. The first involved 213 patients who received care from 19 registered nurses (RNs) and six nurse aides (a proportion of 76% RNs); the second phase saw 209 patients receive care from 23 RNs and no nurse aides; and the third involved 254 patients cared for by 23 RNs and two nurse aides (or 92% RNs).

The researchers found that patients in the groups with 76% and 92% RNs had a higher rate of urinary tract infections than the all-nurse group, and incurred higher nursing costs.

The all-nurse group had a higher ventilator weaning rate than the group with 76% RNs, but also had higher rates of medication errors than this group, and higher rates of bloodstream infections than both groups. The researchers said one possible explanation for this was that the all-nurse group tended to change a patient’s dressing immediately after bathing them, possibly not washing their hands in between.

The authors said that the instruction and supervision of nurse aides can increase RN workloads. They recommended that hospitals employ and train their own nurse aides to maintain patient safety and improve quality of care.

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