Study: Nursing skill mix linked to mortality, quality

Editor's Note

This study led by Linda H. Aiken, PhD, University of Pennsylvania School of Nursing, Philadelphia, finds that employment of more nurse assistants relative to the number of professional nurses in hospitals is associated with higher mortality and lower quality of care.

Every 10-point increase in the percentage of professional nurses was associated with lower odds of:

• mortality (OR=0.89)
• low hospital ratings from patients (OR=0.90)
• reports of poor quality (OR=0.89)
• poor safety grades (OR=0.85)
• other poor outcomes (0.80<OR<0.93).

Each 10 percentage point reduction in the proportion of professional nurses was associated with an 11% increase in the odds of death.

The study included a review of 275,519 general surgery patients in 242 European hospitals. A total of 18,828 patients rated their hospital experience, and 13,077 nurses in the hospitals reported on staffing levels and quality and safety of care.

For the RN4CAST Consortium 2Faculty of Health Sciences, University of Southampton, Southampton, UK 4University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium 5Department of Healthcare Management, Technische Universitat Berlin, Berlin, Germany Correspondence to Dr Linda H Aiken, University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy