First let’s deal with the title ‘Nurse’. In the UK it is illegal to call yourself a nurse if you are not on the register, Nurse is a legally protected title…this is a fact which gets lost in media talks about poor ‘nursing’.
Too much ‘nursing’ is in fact done by care assistants.
Too many student nurses are being supervised by care assistants.
Care assistants often are good people trying their best but they are not always supported, trained or supervised enough. They need to support nurses in their roles rather than replace them, which is in fact what is happening.
In ‘Skill mix and the effectiveness of nursing care’ Carr-Hill (1992) argued that ‘grade mix had an effect on the quality of care in so far as the quality of care was better the higher the grade (and skill) of the nurses who provided it’. In other words skilled nurses reduce poor quality care.
In the United States a Philadelphia hospital (2012) adopted an all RN care model, they eliminated the use of care assistants and patient outcomes improved and costs reduced.
This comes on the back of another 2006 in the US study indicating that increasing the ratio of nursing by RNs reduces stay, adverse outcomes and patient deaths.
Finally as published on the nursingtimes.net a UK study suggests:
“There is a link between higher death rates and the number of healthcare assistants employed in NHS hospitals”.
A study by the University of Southampton found trusts with a higher number of unregulated HCAs also had a higher mortality rate.
A higher HCA-to-bed ratio increased the mortality rate up to a maximum of 5.4% more than would be expected, the new study found.
The study also identified a clear link between the number of registered nurses and mortality. It found there were fewer deaths the more nurses were employed. For every 10% increase in the number of registered nurses the odds of patients dying dropped by almost 7%.
Based on hospital admissions in 2010-11, the study found a 10% increase in the number of nurses would result in 2,600 fewer deaths.
Lead study author Professor Peter Griffiths told Nursing Times the findings on HCAs needed further investigation, but said: “It certainly calls into question a workforce strategy that moves registered nurses further away from the bedside and replaces them with assistants.
“This echoes some of the findings of the [Mid Staffordshire Public Inquiry] report, which expressed concern over the lack of regulation for this workforce.”
Professor Griffiths added: “The fewer registered nurses a hospital has, the more patients die. So the significance of nurse staffing levels seems to be well established both in the research and in the tradition of the profession.”
He added that, while the government appeared “dead set” against introducing mandatory staffing levels, “there is surely a level at which we can be clear it cannot be safe under any circumstances.”
He suggested a ratio of eight patients per nurse, saying in his study 60% of shifts were at this level or better.
“The findings taken as a whole point to the need for more qualified nurses at the bed side,” Professor Griffiths said. “It is hard to conclude from this evidence that the solution lies in downgrading the training of the nursing workforce as a whole and reducing the number of registered nurses.”
On Graduate nursing:
Reference Aiken et al (2003) Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA 290(12):1617-1623
June Girvin argues: The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.