NR 351 Week 6 Nurse Staffing Article Summary Example

Summary of Aiken et al. (2014): Nurse Staffing, Nurse Education and Surgical Mortality in Nine European Countries

Student Name

College of Nursing, Chamberlain University

NR 351: Foundational Concepts for the Practicing RN

Instructor Name

Month Day, Year

Summary of Aiken et al. (2014): Nurse Staffing, Nurse Education and Surgical Mortality in Nine European Countries

Purpose of the Article

Aiken et al. (2014) set out to determine whether two features of hospital nursing, the number of patients each nurse cares for and the proportion of nurses educated at the bachelor's level, were associated with the chance that surgical patients died within 30 days of admission. The study was part of a large European research program on the nursing workforce, and it was designed partly to inform policy decisions in Europe at a time when some countries were considering reductions in nurse staffing and debating the level of education required for nurses.

Method

The researchers used an observational design that combined two sources of data. The first was a survey of more than 26,000 nurses working in 300 hospitals in nine European countries: Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden and Switzerland. From the survey, the researchers calculated each hospital's average number of patients per nurse on the nurses' most recent shift and the percentage of nurses holding a bachelor's degree. The second source was hospital discharge data for more than 420,000 patients aged 50 years and older who had common general, orthopedic or vascular surgery in those hospitals. The outcome was death within 30 days of admission. The analysis adjusted for patient characteristics, such as age, sex and type of surgery, and for hospital characteristics, such as size, teaching status and technology, so that hospitals caring for sicker patients were not unfairly compared with others.

Findings

The study reported two main associations. After adjustment, every extra patient in a nurse's assignment went along with roughly 7 percent higher odds of death in the month after admission. In the other direction, for every additional ten percentage points of the nursing staff with a bachelor's degree, the odds of death fell by roughly 7 percent. The authors illustrated the combined size of these associations by comparing hypothetical hospitals: patients in hospitals where 60 percent of nurses held bachelor's degrees and nurses cared for an average of six patients would have almost 30 percent lower mortality than patients in hospitals where only 30 percent of nurses held bachelor's degrees and nurses cared for an average of eight patients.

The size of the associations varied from country to country in the data, and the hospitals differed widely in both staffing and education. The findings are associations measured at the hospital level; they do not describe what happened to individual nurses' patients.

The Authors' Conclusions

The authors concluded that reducing nurse staffing to save money could harm patients, and that increasing the proportion of nurses with bachelor's degrees could reduce preventable hospital deaths. They argued that these findings should inform European policy on nurse workforce planning and education, particularly where cost-cutting measures were being considered.

Limitations the Authors Acknowledged

The study was observational, so it could show that staffing and education were associated with mortality but could not prove that changing them would change mortality. Staffing was measured through nurses' reports of their last shift rather than through payroll records, although the authors noted that nurse reports have been shown to be reliable in earlier work. Mortality was taken from discharge data, which can vary in completeness between countries, and the study could not account for every difference among hospitals that might affect both staffing and patient outcomes. These limits do not cancel the findings, but they mean the study supports its conclusions as strong associations across many hospitals rather than as proof of cause.

Relevance to the Summarizer's Practice

The course asks for a brief note, kept separate from the summary, on why the article matters to the writer. The writer works on a surgical unit in the United States where patient loads of five or six per nurse are typical on day shift and six or seven at night, and where the hospital has recently begun preferring bachelor's-prepared nurses for new positions. The article does not settle whether those specific numbers are safe, because it studied European hospitals and hospital-level averages. What it offers is evidence that both workload and education are associated with surgical mortality across a very large sample, which gives the writer a scholarly basis for understanding why staffing and education requirements are debated rather than simply accepting or resenting them.

References

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8