'Staff shortages lead to more deaths'

UAntwerp research links lower nurse staffing to higher hospital mortality

A new study by researchers from UAntwerp has found that the number of nurses working on a hospital ward affects the mortality rate of the patients in their care. Their conclusion: more nurses per patient means fewer unexpected patient deaths.

The scientists collected administrative and medical data from 34,267 patients in seven hospitals: four in Flanders, one in Wallonia and two in Brussels. “There were approximately three unexpected deaths per 1000 patients in these hospitals”, says researcher Filip Haegdorens (UAntwerp). The researchers defined an ‘unexpected death’ as any case in which a patient suddenly died during active treatment when no palliative or terminal care plan had been drawn up.

“We know from previous research that some of these unexpected deaths are avoidable, which is obviously tragic and distressing to both the family and the care providers involved. The healthcare sector should therefore make every effort to prevent any avoidable deaths. Previous research has already established a link between the number of nurses available and total mortality. But what’s new in our research is that we used more objective data, collected over a longer period of time and statistically adjusted for possible confounders, which enabled us to achieve a high level of certainty about our results.”
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Room for improvement in Belgium
According to the study, the average hospital nurse is caring for 9.7 patients (range 6.6–11.9) at any one time. On 89% of all wards, the number of nurses per ward proved insufficient to ensure high-quality care. Compared to Australian hospitals, for instance, where minimum nurse ratios are stipulated by law, there is definitely room for improvement in Belgium. Haegdorens and his colleagues were also able to establish a link between the nurses’ education level and the number of unexpected deaths: on some wards, it was found that more nurses with a higher education level also reduced the risk of unexpected death.

Haegdorens: “In Belgium, there are two different nurse education levels: the Bachelor’s degree nurse (EQF level 6) and the certificate nurse (EQF level 5). International experts have long called for more highly educated nurses to care for hospital patients, as this improves the quality of the care provided.”

Need to optimise hospital nursing staff
The goal of the National Academy of Medicine in the United States is for 80% of all nurses to have a Bachelor’s degree by 2020. In Belgium, about 59% of hospital nurses have a Bachelor’s degree. Nursing care has changed dramatically in recent years and now requires thorough clinical knowledge and insight into disease processes, in addition to care tasks. Because care has become so much more complex, more extensive knowledge and skills are needed. That is why highly educated nurses are essential to be able to provide high-quality care today.

The researchers believe that optimising the nursing staff in care institutions should be an objective for the Belgian authorities. Haegdorens: “However, the situation is complex and requires a well-thought-out solution. We found in our research that some services would stand to benefit from having more nurses, regardless of their level of education, while other services specifically need more highly educated nurses. In either case, our conclusion remains that there is a need for better staffing in order to ensure the quality of care.”

Read the full research article on Research Square