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Missed nursing care due to staff shortages increases mortality rates, study finds

Necessary care more likely to be missed 
Jane Ball

Missed patient care due to nursing staff shortages increases hospital death rates, a major international study reveals today.

Nurse academic and lead researcher Jane Ball said the findings provide the missing link in understanding mortality rates when nurse staffing is low, necessary care is left undone.

The investigation into nurse staffing in nine European countries, including 31 NHS acute trusts in England, found mortality rates increase for each amount of care missed.

Each 10% increase in the amount of care left undone was associated with a 16% increase in the likelihood of a patient dying following a common surgical procedure, the study shows.

Bigger picture

University of Southampton principal research fellow Dr Ball, who led the research published in the International Journal of Nursing Studies, said:

Missed patient care due to nursing staff shortages increases hospital death rates, a major international study reveals today.


Lead researcher Jane Ball said understaffing puts patients’ lives at risk.
Picture: Nathan Clarke

Nurse academic and lead researcher Jane Ball said the findings provide the ‘missing link’ in understanding mortality rates – when nurse staffing is low, necessary care is left undone.

The investigation into nurse staffing in nine European countries, including 31 NHS acute trusts in England, found mortality rates increase for each amount of care missed.

Each 10% increase in the amount of care left undone was associated with a 16% increase in the likelihood of a patient dying following a common surgical procedure, the study shows.

Bigger picture

University of Southampton principal research fellow Dr Ball, who led the research published in the International Journal of Nursing Studies, said: ‘For years we have known there is a relationship between nurse staffing levels and hospital variation in mortality rates, but we have not had a good explanation as to how or why.

‘These results give the clearest indication yet that registered nurse staffing levels are not just associated with patient mortality, but that the relationship may be causal.’

Dr Ball added: ‘If there are not enough registered nurses on hospital wards, necessary care is left undone, and people’s lives are put at risk.’

The findings published today come from further analysis of the RN4CAST study, which has previously shown that lower nurse staffing levels are associated with higher mortality.

The new research measured missed nursing care via a nurse survey, and asked questions on activities such as patient surveillance, administering medicine on time, adequate documentation, comforting patients and pain management.

High price

Responding to the study, RCN general secretary Janet Davies said: ‘Despite years of warnings, hospitals across the country do not have enough nurses. This research puts beyond doubt the fact that patients pay the very highest price when the government permits nursing on the cheap.

‘As the nurse shortage bites, hospitals are filling wards with unregistered healthcare assistants in a bid to cope, especially at night. Ministers cannot ignore further evidence that the lack of registered nurses leads to people left in pain for longer and with a higher risk of not recovering at all.’

The analysis also looked at nurse qualifications and confirmed that hospitals with higher numbers of registered nurses trained to degree level have a lower risk of patient mortality. 

Ms Davies added that when nurses are pulled in every direction ‘important things are inevitably missed’, and said patients stand a better chance of recovery when there are more degree-trained nurses on the wards.

‘The government must redouble its efforts to train and recruit more nurses and stop haemorrhaging experienced professionals who feel burnt out and undervalued,’ she added. ‘In the forthcoming Budget, the chancellor must scrap the public sector pay cap that stands in the way.’


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