Replacing nurses with unqualified assistants 'dramatically endangers lives'

The use of unqualified healthcare assistants in hospitals dramatically endangers the lives of patients, according to shocking new research.

The cost-cutting practice, dubbed “nursing on the cheap”, is associated with a rise of more than a fifth in the odds of dying in a hospital.

The Europe-wide report, published in the journal BMJ Quality & Safety, said replacing qualified nurses was not “in the public interest”.

It drew on survey responses from just over 13,000 nurses in 243 hospitals and nearly 19,000 patients in 182 of these hospitals.

The final analysis showed a higher proportion of professionally qualified nurses was associated with a significantly lower risk of death, higher levels of patient satisfaction, and fewer reported indicators of poor quality care, such as bedsores, falls, and urinary infections.

Every 10% increase in the proportion of professionally qualified nurses was associated with an 11% fall in the odds of a patient dying after surgery, a 10% fall in the odds of patient dissatisfaction, and an 11% fall in the odds of reporting poor quality care.

Financial pressures, healthcare reforms, and staff shortages are forcing hospitals to look at their nursing skill mix.

In England, for example where a new category of hospital caregiver, called a nursing associate, has been introduced the skill mix varies from 79% of professional nurses to 47%. The average of 57% is one of the lowest in Europe.

This new study analysed the link between nursing skill mix and the risk of patient death, patients’ views of their care and other indicators.

MORE: Accused killer of MP Jo Cox said was acting ‘for Britain’, court hears
MORE: Martin Lewis: I got death threats after Remainers used picture for campaign leaflets

The study found that in a hospital with average nurse staffing levels and skill mix, substituting just one professionally qualified nurse with a nursing assistant for every 25 patients was associated with a 21% increase in the odds of dying.

Dr Linda Aiken, of the University of Pennsylvania School of Nursing, and colleagues said: “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.”

She added: “In a context in Europe in which hospital nurse staffing is a frequent target for budget reductions, and policy makers are suggesting the introduction of lower skilled and less educated nurse substitutes like ‘nursing associates’, our results suggest caution is warranted.”

The researchers said: “Findings from this large and unique study of nursing skill mix in European hospitals suggests that caution should be taken in implementing policies to reduce hospital nursing skill mix because the consequences can be life threatening for patients.

“Beyond risking preventable death among hospitalised patients, the erosion of nursing skill mix could negatively impact overall quality and safety of care as well as patients’ perceptions of the adequacy of their hospitals at a time when there are growing concerns about eroding hospital care quality.”