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Wednesday 29 November 2023 Dublin: 2°C
patient safety

Patients more likely to die when cared for by nurses with heavy workloads

In Ireland, the average patient-to-nurse ratio is 6·9, which is mid-range in comparison to other European countries.

THE LARGEST INVESTIGATION of nursing and hospital outcomes in Europe has found that patients are more likely to die after common surgical procedures when they are cared for in hospitals with heavier nurse workloads and fewer nurses with bachelor’s degrees.

The research, published in The Lancet, looked at 42,0000 patients in 300 hospitals across nine European countries, including Ireland.

The study indicated that every extra patient added to a nurse’s average workload increases the chance of surgical patients dying within 30 days of admission by 7 per cent, but a 10 per cent increase in the proportion of nurses holding a bachelor degree is associated with a 7 per cent decrease in the risk of death.

The pan-European study emphasises the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, says Professor Linda Aiken from the University of Pennsylvania School of Nursing, USA, who led the research.


Speaking to, Professor Anne Scott, Dublin City University said that in the Irish context, 30 out of the 31 acute hospitals which have over 100 beds were included in the study. She said the study focused on surgical and medical wards.

“The patient- nurse ratio for Ireland is in the mid-range, ” she said, adding that the results might mask the variance that can be found in different hospitals and also within different wards within the same hospital.

In Ireland, the average patient-to-nurse ratio is 6·9, found the study. The ratios for other European countries were 12·7 in Spain and 10·8 in Belgium and 5·2 in Norway. In Spain and Norway, all nurses had a bachelor’s degree compared with an average of just 10 per cent in Switzerland and 28 per cent in England.

“What we are saying through this research is that if a nurse already has eight patients, to add another one to her workload appears to increase the risk to the patient,” said Scott.


The researchers analysed responses from more than 26,500 nurses and reviewed medical records for 42,2730 patients aged 50 years or older discharged after common surgery such as hip or knee replacement, appendectomy,  gall bladder surgery and vascular procedures in nine European countries – Belgium, England, Finland, Ireland, the Netherlands, Norway, Spain, Sweden, and Switzerland.

The overall percentage of patients who died in hospital within 30 days of admission was low, ranging by country within an average of 1·0―1·5 per cent.

However, in every country, death rates varied significantly across individual hospitals, ranging from hospitals where less than 1 per cent of patients died, to hospitals where more than 7 per cent died.

The findings suggest that patients have the highest risk of death after surgery in hospitals where nurses with lower levels of education care for more patients.

In a hospital where nurses care for an average of six patients each and the proportion of nurses with bachelor’s degrees is 60 per cent or greater, the risk of hospital deaths would be almost 30 per cent lower than in hospitals where nurses care for an average of eight patients, and in which only 30 per cent of nurses have bachelor’s degrees.


“Since 2006, nurses have been required to hold degrees in Ireland,” said Scott, adding, that the study showed that 58 per cent of respondents to the study held a nursing degree in Irish hospitals.

However, she added that there were variances in hospitals and in wards, where it could range from 35 per cent on one ward, to 81 per cent on another. “In Ireland, we need to become much more aware of out nursing profiles in the hospitals,” she said.

She said that one of the difficulties they came up against during the study is that the education profiles of the nurses working in Irish hospitals is not held centrally, adding that they had to get the information on education levels from the nurses themselves.

Scott said that research needs to be carried out into what percentage of nurses working in Irish hospitals have degrees so as to ensure that wards where the percentage is lower, nurses can be moved around the system to ensure better patient safety.

Read: Remember the ’24 No More’ campaign? Hospitals still aren’t complying say IMO>

Read: Graduate nurses to protest “€6.49 per hour” training wage>

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