howard catton head of policy the business case for nursing
TRANSCRIPT
Howard Catton
Head of Policy
The business case for nursing
Projections: % Change in NHS nurses2006/7 to 2015/16, England (wte)
-14
-12
-10
-8
-6
-4
-2
0
2
4
6
2006/7 2015/16
%
Buchan/Seccombe best case
Buchan/Seccombe worst case
WRT projection (est.)
(sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008)
RCN Evidence Base for Future Nurse
Reductions in:• Patient Mortality• Respiratory, Wound and Urinary Tract Infections• Number of Falls• Incidence of Pressure Sores• Medication ErrorsImprovements in:• Patient Functional Independence• Patient Experience and Perceptions of Health Care
http://www.rcn.org.uk/support/policy/policybriefings
As workloads in hospitals increase, so does mortality ...
65
70
75
80
85
90
95
4 6 8
65
70
75
80
85
90
95
20 40 60
But as nurse education increases, mortality decreases …
Dea
ths
per
1000
pat
ient
s w
ith
com
plic
atio
ns*
Staffing (Patients per nurse) Education (% of nurses with degrees)
*Adjusting for patient and hospital characteristics
L. Aiken, Univ. of Pennsylvania
Inpatient Mortality Rates in 118,803 English Surgical Patients From 30 Trusts in Relation to Nurse Staffing Levels
2
2.2
2.4
2.7
1
1.21.4
1.6
1.82
2.2
2.42.6
2.8
Lowest Pt:NurseRatios
Highest Pt:NurseRatios
Cru
de
mor
tali
ty r
ate
%
Rafferty, Clarke, Aiken et al., in review
Dr Foster Intelligence; Nursing Times, 31 March 09
147 Trusts
Those with a low nurse per bed ratio were twice as likely as those with a high ratio to have a high HSMR
Mid Staffs, Maidstone & Basildon Reg v Non Reg and Clinical Staff per Bed ratio
L. Aiken, Univ. of Pennsylvania
Patient to Nurse Ratios Important in Nurse Retention
• Higher burnout and greater job dissatisfaction (precursors of turnover) are strongly related to patient-to-nurse ratios.
• An increase of 1 patient per nurse increases the probability of – high levels of burnout by 23% – job dissatisfaction by 15%
• Good HR• T& D• Team Working • Appraisal- All reduce mortality
West et al; 2002West et al; 2002
““Services better at Trusts Services better at Trusts with the happiest nurses”with the happiest nurses”
Nursing Times, 23 March 2010Nursing Times, 23 March 2010
L. Aiken, Univ. of Pennsylvania
Onerous Workloads and Chaotic Environments: Latent Conditions Creating Possibility of Errors
State of the Art Metrics for Nursing; Griffiths, Kings Univ 08
“Front Runners”• Failure to Rescue• HCAI• HCA pneumonia• Pressure Ulcers• Falls
Staffing levels, patterns and satisfaction
National Nursing Research Unit, Kings College 09
• “better clinical and cost outcomes are achieved by a qualified nursing workforce comprised primarily of RNs”
• “there is little evidence to suggest a benefit from replacing unlicensed NAs with LPNs”
Specialist Nurses, Changing Lives Saving Money. RCN 2010
• Reduce Emergency Admissions• Increase Independence• Health Education and Prevention Advice• Care Planning and Co-ordination• High Patient Satisfaction
“Interventions by specialised nurses were shown to have a beneficial impact on a range of outcomes for LTC when compared with usual care.”
“There is no clear evidence of a differential effect on outcomes between nurses as first contact and providers of ongoing primary care when compared with doctors, though patient satisfaction may be higher with nurse led care.”
EPPI Centre, Institute of Education, EPPI Centre, Institute of Education, University of London 2009 University of London 2009
“Secondary prevention care for heart disease provided by specialist cardiac nurses and general practice nurses compared with GPs was found to improve mortality rates, general health, diet and levels of exercise and anginal symptoms. Other comparative benefits include increased patient follow up rates and reduced hospital admissions.”
EPPI Centre, Institute of Education, EPPI Centre, Institute of Education, University of London 2009 University of London 2009
Dall et al, Medical Care January 09
• $1.3 bn per year productivity• Reduction 3.6m hospital days• $6.1bn medical savings• 133,000 RNs save 5,900 lives per year
CNO / NHS Institute for I&IHigh Impact Changes
• Pressure ulcers occur in 4-10% of patients admitted to acute hospital in the UK
• Costs range (1-4) £1K - £24K• Av DGH £1m - £3m• Total cost for UK £1.4bn - £2.1bn
REGISTERED NURSES
PATI
ENT
OU
TCO
MES
x
Key Questions for a Trusts Board
• Patient/Quality Care Impact Assessment
• Actual v Establishment Staffing Levels
• Reg v Non Reg Ratio
• Nurse to Bed and Patient Ratios
• Spend on Training and CPD
Who said …………..
“One has to grow hard but without ever losing tenderness”
