Published: 26-02-2014 08:10 | Updated: 26-02-2014 17:49

Better nurse staffing and education reduces risk of patient mortality after common surgery

Hospital nurse staffing and the proportion of nurses with bachelor’s level education are associated with significantly fewer deaths after common surgical procedures, according to a new international study in which researchers at Karolinska Institutet participated. The study of close to a half million surgical patients and over 26 000 nurses in 9 European countries is published in the scientific journal The Lancet.

The team of researchers found that every one patient increase in patient to nurse ratios was associated with a 7% increase in deaths, while having a better educated nurse workforce is associated with fewer deaths. Every 10% increase in bachelor’s degree nurses is associated with a 7% decline in mortality.

The proportion of nurses with a bachelor’s degree differs greatly among European countries. About 60% of the Swedish nurses participating in the study had a bachelor’s degree. This level of academic education is required to become a licensed nurse in Sweden since 2007. The Swedish co-authors of this study conclude that recent suggestions to lower the proportions of registered nurses to save money, points to a development in the wrong direction.

“Our research shows the importance of both level of education and workload in relation to patient mortality”, comments Carol Tishelman, a Professor of Nursing at the Medical Management Centre at Karolinska Institutet. “It is appropriate that a bachelor’s degree is required for nurse licensure in Sweden, however, this is not the case throughout the EU.”

The study was led by researchers at Center for Health Outcomes and Policy Research at University of Pennsylvania, within the RN4CAST project (Nurse forecasting in Europe), which in turn is funded by the EU’s FP7 Health and the NIH. In addition to USA and Sweden, partnering researchers in the RN4CAST comes from Belgium, Botswana, China, Finland, Germany, Greece, Ireland, Norway, Poland, Spain, South Africa, Switzerland, the Netherlands and the UK.


Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
Linda H Aiken et al.
The Lancet online 26 February 2014