Research finds swapping fully qualified nurse for assistant increases risk of dying but government says new staff will complement, not replace, nurses
Government plans to tackle NHS understaffing by putting thousands of “nursing assistants” on to wards are under scrutiny after research found deploying them could raise patients’ risk of dying.
The study, published in the journal BMJ Quality and Safety, found that replacing one fully qualified nurse with a nursing assistant on a ward of 25 patients increased the risk of a patient dying by 21%.
It has emerged just before the first 1,000 nursing assistants due to work in NHS hospitals in England start their training. The findings were based on research in adult acute care hospitals in six European countries, including England and the Republic of Ireland.
The study has sparked fresh fears that the introduction of nursing assistants, who are intended to help counter the NHS’s shortage of an estimated 20,000 nurses, will damage patient safety.
The research, led by Dr Linda Aiken of Pennsylvania University’s school of nursing, concludes: “A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses.
“Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.”
The Royal College of Nursing warned that relying increasingly on nursing assistants to look after patients was misguided, dangerous and potentially “catastrophic”.
Janet Davies, its chief executive and general secretary, said: “This research reinforces the stark fact that for patient care to be safe, and high quality, you need the right number of registered nurses. Substituting registered nurses with support staff quite simply puts patient care and patients’ lives at risk.
“Support staff are crucial in delivering patient care and the NHS could not operate without them, but they cannot and must not become a substitute for registered nurses.”
Thefact that nurses are educated to degree level and have a wide range of experience in clinical settings means they can spot if a patient’s health is deteriorating or they are having serious complications, allowing them to make and act on decisions in complex and unpredictable circumstances, Davies added.
She said: “Staff and patients can see the effects when staffing levels become diluted. In some instances the effects can be catastrophic.”
The study is based on data from 13,077 nurses in 243 hospitals and 18,828 patients in 182 of the same hospitals in the six countries. It found: “Richer skill mix, for example every 10-point increase in the percentage of professional nurses among all nursing personnel, was associated with lower odds of mortality, lower odds of low hospital ratings from patients, and lower odds of reports of poor quality, poor safety grades and other poor outcomes.”
However, the Department of Health stressed that nursing assistants would complement rather than replace existing nurses and nursing care support workers. It pointed out that the research was conducted in 2009-10, years before the Francis report in 2013 into the Mid Staffs hospital scandal. It led to NHS trusts hiring many more nurses after the inquiry found that shortages of nurses on the wards contributed significantly to appalling care at Stafford hospital between 2004 and 2009.
There are 173,000 nurses working in the NHS in England, 10,000 more than in 2010, a DH spokesman said.
“NHS staff are our greatest asset, and our plans will see 1,000 nursing associates complement, not replace, existing fully qualified registered nurses and nursing care support workers. This will ensure that nurses can make the best use of their time in providing outstanding patient care”, he said.
“Specifically, these findings are based on research conducted between 2009-10 – which has no proper comparison with our new nursing associate role. Patient safety in the NHS has come a long way since the [Mid Staffs scandal]. We have implemented the Francis report following Mid Staffs, recruited over 10,000 more nurses to our wards, and patients say they have never felt safer in hospitals.”