Patient Safety = Nurses
File this one under the “duh” heading. A study out of Europe has found that patients do better with more educated nurses and lower nurse-patient ratios. Here’s the link: http://www.nytimes.com/2014/03/31/world/europe/nurse-education-level-affects-death-rates-study-says.html.
This is what the researchers did: they reviewed charts and nursing employment files at 300 hospitals across 9 countries. All patients 50 years and older who had surgery for general, orthopedic, or vascular problems were included. So, retrospective, but very large sample size – 422,730 patients. There were two main findings:
1. For every 10% increase in the proportion of nurses with bachelor’s degrees, there was a 7% drop in post-surgical mortality.
2. For every 1 patient increase in the nurse-patient ratio, mortality rose 7%.
The NYT article suggests that the reasons for these findings are matters up for debate. No, they’re not. As I’ve said many times, you don’t go to a hospital for a doctor. You go because you need a nurse. The better educated your nurse is, and the few patients he/she has, the better care you will get. Period. The quality of the doctors, physical plant, janitorial staff, candy-stripers, or CEO doesn’t matter.
Here are some reasons for the findings in the Lancet study. Say you are an 80-year-old woman and you come in for an hip fracture. I’ve used this little old lady before, and she will be me someday. You are old but you have all your wits about you, and then some. In order for you to make it out of the hospital alive, and to still be alive 6 months later, you need some specific things from your nurse: adequate pain management, good food, plenty of fluids and rest, someone to look at your wound and dress it carefully, someone to force you to get out of bed, good physical therapy, adequate referrals for rehabilitation, an advocate and liaison with the surgical staff, and someone who knows what to do if something goes wrong. The more your nurse understands your condition and the underlying physiology, the more these tasks will be correctly accomplished. I am not impugning nurses who are not bachelor’s trained; many of them make up in experience what they lack in education. But for new nurses, a bachelor’s is going to provide an head-start.
How can your nurse do all of these things for you and for 7 others? She can’t, of course. In my opinion, nurse-patient ratios are one of the most important determinants of patient outcomes. Lower ratios are more expensive, it’s true. But remember, you go to the hospital because you need a nurse. You want patient safety and high quality? Provide an adequate number of well-educated nurses. It really is as simple as that.