Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing and missed care measures.

They find that every one patient added to a nurse’s workload is associated with a seven percent increase in the odds of 30-day mortality, and a 10 percent increase in missed nursing care is associated with a 16 percent increase in the odds of 30-day mortality. Statistical analyses show an increase between nurse staffing and missed care, and a subsequent association between missed care and mortality. This supports the hypothesis that missed nursing care mediates the relationship between RN staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.