-- Mary Elizabeth Dallas
TUESDAY, Feb. 25, 2014 (HealthDay News) -- Patients who've
undergone common surgical procedures are more likely to die if they
are being treated in hospitals where nurses have heavier workloads
and fewer nurses hold a bachelor's degree, according to a new
The findings, published Feb. 25 in
The Lancet, suggest that "a safe level of hospital nursing
staff might help to reduce surgical mortality, and challenge the
widely held view that nurses' experience is more important than
their education," the study's leader, Linda Aiken, a professor from
the University of Pennsylvania School of Nursing, said in a journal
In conducting the study, the researchers examined surveys of
more than 26,500 nurses. They also reviewed the medical records of
more than 420,000 patients 50 or older after they went home from
the hospital following common surgical procedures, such as a joint
replacement or gall bladder surgery.
The researchers also considered the patients' age, sex, type of
surgery and whether or not they had any other medical conditions to
assess their individual risk of death. After taking these factors
into account, the study authors analyzed how the level of nurses'
education affected patient outcomes.
The patients were treated at 300 hospitals across nine European
countries. The researchers also considered details about these
hospitals, including their size, the availability of certain
technology and whether or not it was a teaching hospital.
The study authors found that each additional patient who was
added to a nurse's workload increased by 7 percent the odds of
surgical patients dying within 30 days of their surgery. On the
other hand, the findings revealed that a 10 percent increase in the
proportion of nurses with a bachelor's degree was linked to a 7
percent drop in patients' risk of death.
The study also revealed that nurse workload and education levels
varied greatly from one country to the next. Although there were,
on average, 12 patients for every seven nurses in Spain, in Belgium
there were 10 patients for every eight nurses. Meanwhile, there
were six patients for every nine nurses in Ireland, and five
patients for every two nurses in Norway.
All the nurses from Spain and Norway included in the study had a
bachelor's degree. However, only 10 percent of nurses in
Switzerland and 28 percent in England also completed this level of
education, the study authors noted.
The researchers suggested that there would be a nearly 30
percent reduction in the risk of death after surgery in hospitals
where nurses care for an average of six patients instead of eight,
and the proportion of nurses with bachelor's degrees is at least 60
"Our findings emphasize the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelor's education for nurses could reduce hospital deaths," Aiken said.
While the study found an association between nurses' workload,
education levels and patient results, it didn't prove the existence
of a cause-and-effect relationship.
Commenting on the study's findings, Alvisa Palese, from the
University of Udine in Italy, and Roger Watson, from the University
of Hull in England, wrote: "The study by Aiken and colleagues
provides evidence in favor of appropriate nurse-patient ratios and
also provides support for graduate education for nurses. Whether
these findings are used to inform health-care policy or how they
are implemented in practice will be interesting to see. We fear
that the evidence here will not be tried and found wanting, but
will rather be deemed too expensive to act upon."
The U.S. Agency for Healthcare Research and Quality has more on
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