Nursing Assistants Replacing Nurses Results in Heightened Risk

Substituting professionally qualified nurses with lower skilled nursing assistants is linked to a heightened risk of patient death and other indicators of poor quality care, claims a new study.

Researchers at the Institute of Nursing Science (Basel, Switzerland), the Leuven Institute for Healthcare Policy (Belgium), and other institutions conducted a study that collected cross-sectional patient discharge data from 13,077 nurses in 243 adult acute care hospitals, and 18,828 patients in 182 of the same hospitals in Belgium, England, Finland, Ireland, Spain, and Switzerland.


They also collected discharge data for 275,519 surgical patients in 188 of these same hospitals, in order to determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care, and other indicators of quality of care. The main outcome measures included patient mortality, patient ratings of care, care quality, patient safety, adverse events, and nurse burnout and job dissatisfaction.

The results revealed that a richer nurse skill mix was associated with lower odds of mortality, lower odds of low hospital ratings from patients, and lower odds of poor quality reports, poor safety grades, and other poor outcomes. Each 10% reduction in the proportion of professional nurses was associated with an 11% increase in the odds of death. Additionally, in hospitals with a higher proportion of professionally qualified nurses, they were less likely to experience burnout or to be dissatisfied with their jobs. The study was published on November 15, 2016, in BMJ Quality & Safety.

“In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying,” concluded senior author Walter Sermeus, MD, of the Leuven Institute for Healthcare Policy, and colleagues. “Our study adds new and important evidence that diluting hospital nurse skill mix by adding lower skilled nurse assistants and/or reducing professional nurses is not in the public interest.”

Nursing assistants, sometimes called nursing aides, help provide basic care for patients in hospitals and residents of long-term care facilities, such as nursing homes. Their duties include helping patients bathe, dress, and feed themselves; taking patient vital signs; serving meals, making beds, and keeping rooms clean; setting up medical equipment and assisting with some medical procedures; and answering calls for help and observing changes in a patient’s condition or behavior.

Related Links:
Institute of Nursing Science
Leuven Institute for Healthcare Policy