Low RN staffing levels linked to higher patient mortality risk, study finds

Increasing the number of unregistered nursing assistants used to care for hospitalized patients may not be a safe solution to the nationwide nursing shortage, suggests the findings of a study published in BMJ Quality & Safety.

For the study, researchers examined staffing level data on registered nurses and unregistered nursing assistants at a large acute care hospital in England. The clinicians treated 138,133 adult patients admitted to 32 wards between April 2012 and March 2015.

Researchers measured staffing levels as hours per patient per day relative to a specific ward's average. Across all 32 wards, registered nurses had an average staffing level of 4.75 hours per day, compared to 2.99 hours per day for nursing assistants.

On average, patients experienced two days of low staffing levels for nurses and nursing assistants within the first five days of their hospital stays, which equated to a cumulative shortfall of 23 and 15 minutes, respectively.

The overall mortality rate was 4 percent during the study period. Researchers found the risk of dying rose 3 percent for every day a patient had low registered nurse staffing levels. In contrast, every additional hour a nurse spent caring for a patient was associated with a 3 percent drop in mortality risk. Both low and high nursing assistant staffing levels were also linked to a higher mortality risk.

"The findings of this paper suggest potential benefits from increasing the availability of [registered nurses] on acute hospital wards," the researchers said in a press release. "However, in England, RN shortages look set to continue in the short term. ... [These] are unlikely to be remedied by increasing the numbers of lesser trained nursing staff in the workforce."

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