Weekend nurse - patient ratio on stroke units found to adversely affect mortality
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I read with interest a piece of research which adds to the debate regarding increased mortality of patients admitted to hospital at weekends. This study, led by Dr Benjamin Bray of King's College London, looked at both senior medical staff and nursing staff provision on stroke units at weekends. Around half of the units in the study had consultant ward rounds seven days per week, however there was no difference in mortality rates between this group and those with less senior medical cover at weekends.
Interestingly, and perhaps not surprisingly, was the the finding that those stroke units with an average ratio of 1.5 nurses to 10 patients, compared to units with an average ratio of 3 nurses to 10 patient were associated with the equivalent of one excess death per 25 admissions. It seems obvious to me that a higher nurse to patient ratio would lead to improved basic care for any group of patients.
As a nurse myself I have had a good deal of experience in caring for groups of patients in a number of different specialities in the hospital setting. It is necessary that nurses prioritise the care they give and generally those aspects of care which suffer in times of staff shortage are what are considered to be the 'basic' comfort measures; assistance to eat and drink, attending to hygiene needs, toileting, changing position in bed and provision of adequate pain relief to name but a few. Just spending time with a patient during these types of activities can enhance the nurse - patient relationship leading to increased holistic awareness of the patient, enhanced patient satisfaction and, I would suggest, a reduction in patient morbidity and mortality.
The National Institute for Clinical Excellence (NICE) has recently published guidelines which identifies ‘red flag events’ which warn when nurses in charge of shifts must act immediately to ensure they have enough staff to meet the needs of patients on that ward. The guidance suggests that when each registered nurse is caring for more than 8 patients this is a signal to check that the patients are not at risk of harm; senior management and nursing managers should closely monitor red flag events; where basic care needs are not being met, analyse safe nursing indicator data and take action if required.
I have worked in areas previously in which we had regularly been short-staffed but were unable to use agency or bank staff due to government-imposed financial pressures on the Trust. I welcome these National guidelines and hope that nursing staff on the wards will now feel empowered that they have the means to ensure adequate staffing numbers to provide the standard of care their patients deserve and that any nurse would aim to provide.
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