|Male Nurse Action Figure|
An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%, and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7%. ¹Regarding teaching nursing to a degree level I was always a bit astounded that it took such a long time to do in the UK. They were practically running two courses side by side with different University qualifications but both would end up in the same job with the same pay. If you did DipHE you'd have less educational workload and also more financial support and if you did the Degree you'd get more educational workload and student debt. All for the same job, with the same wage. Whereas most countries in Europe have made it a standard that nurses are educated to a degree level.
|Evidence Based Nursing|
Each 10% increase in the proportion of nurses with higher degrees decreased the risk of mortality and of failure to rescue by a factor of 0.95, or by 5%, after controlling for patient and hospital characteristics. This adjusted OR of 0.95 (95% confidence interval, 0.91–0.99) is a multiplicative parameter. ²This study also challenged the notion that experience is better than education. Experience is of course important, but you do need the education to make sense of that experience. So as The Conversation added it has to be both.
oodleplex of paperwork that we'll have to do as soon as we qualify and that is a good point, we have to learn how to write a good concise daily record, reports, handovers and such like. Even before we become fully fledged nurses we have to be sure that we know how to write a CV or supporting statements for job applications. But the main reason is because writing and essay coerces students to do a lot of reading. What some people also don't realise is that it is about the research done around the essay, and the essay can work as evidence of what we have read, what we have learned and in some cases how we can incorporate that into our professional career. Along side this it should also teach students how to evaluate evidence because, and I can't stress this enough, if we want to be taken seriously as a profession that is what we have to base our actions and decisions on evidence. But then you have these people who then complain that some students and some nurses are too posh to wash, well to be honest, yes you do meet them, but very very rarely. Students have to spend half (or as I said before 60%) in clinical settings, they learn that personal care is integral in good care. Those who sign up for nursing only to find out that they have to do chores like that generally quit very very early in the course.
The other important point that this recent study pointed out was the rather obvious statement that the lower workload also saves lives. The RCN had been advocating for some time that the maximum caseload per nurse should be 8 patients. This is something that every nurse and their dog knew, without having to read the daily's. But it seems like the people in power refuse to listen until something big happens. Again this is something that is supported by several studies and hopefully something that NICE will have a say about.
Our results imply that had the proportion of nurses with BSN or higher degrees been 60% and had the patient-to-nurse ratio been 4:1, possibly 3810 of these patients (725 fewer) might have died, and had the proportion of baccalaureate nurses been 20% and had staffing uniformly been at 8:1 patient-to-nurse ratios, 5530 (995 more) might have died. ²Of course there would be better care if there are more staff around. But at the same time that is why this law that the current Minister of Health, stating that all wards should publish what the staffing levels are, is such a big red herring. It is all very well to publish how many staff there are working at any one point, what it doesn't tell you is what the skill mix is, how many nurses there are working, how many health care support workers, how many associate practitioners and so on and so forth. But as this report from the RCN states it is not only beneficial for the patient that we have a higher nurse to patient ratio, it is also a cost-saving mechanism. A survey done for the BMJ in 2012, this involved around 2917 nurses over 401 hospitals wards had this to say:
Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001).It might not look like it in the short term but the long-term benefit of having better educated nurses and more of them as well would lead to more effective care that is given. A meta-analysis done in 2007 concluded that an increase of registered nurses employed was positively associated with "decreased hospital related mortality and adverse patient related events". It would also help to raise the morale of an already spent workforce that has been kicked and tossed around and used as scapegoats for political gains. As Peter Carter said:
“The Francis report [into failings at Mid Staffs trust] showed that on some occasions there were two nurses on 34 bedded wards for elderly people,” said Carter. “The two nurses could have been Florence Nightingale, but with that ratio you simply cannot provide quality care.”
So is it lack of staffing or lack of education that is the problem? Both. It shouldn't be a question of one over the other. When the research shows that it is a lack of both leads down a dark path.¹ "Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study"
² "Educational Levels of Hospital Nurses and Surgical Patient Mortality"