One of the world’s leading experts on nursing and safe staffing has questioned current NHS policies towards nurses and suggested some could even put patients at greater risk.

  • Evidence shows minimum nurse to patient ratios work, says global expert
  • Linda Aiken says there is no evidence the UK has a staffing policy on nursing
  • Substituting nurses for non-nurse roles increases poor outcomes claim

Linda Aiken, director of the Centre for Health Outcomes and Policy Research at Pennsylvania University in the United States, told HSJ evidence on safe nurse staffing ratios was clear and proved “they do work”.

She said the NHS’s plan to create a nursing assistant role at band 4 was “crazy”, as evidence in the US showed this actually increased mortality and poorer outcomes.

“The more non-nurses you have in a hospital setting the worse the outcomes are, especially if you substitute them for nurses. In America, they are called licensed practical nurses and we are getting rid of them because the research shows the more of them we have, the worse the outcomes and they don’t save you any money,” Professor Aiken said.

Professor Linda Aiken

Team based approaches ‘have no place in policy’, Linda Aiken said

She added: “We should learn from each other and there is no reason for the UK to go down that route.”

Professor Aiken, who was speaking during a visit to the Florence Nightingale Faculty of Nursing and Midwifery at King’s College London this week, is considered a pre-eminent expert on nurse staffing and has published more than 300 research papers. Her work includes a paper published in The Lancet last year that showed that for every extra patient added to a nurse’s workload, the risk of death within a month increased by 7 per cent.

The paper, based on data from 300 European hospitals in nine countries, also showed that a 10 per cent increase in the proportion of degree educated nurses was associated with 7 per cent lower death rate.

She said the variation in mortality and outcomes within the NHS was “shocking”. She added: “There is no lack of people in your system who are quality officers, but what I observe here is that there is not a recognition of how important nursing is to get the outcomes you want. Nursing is under-resourced in your country relative to your peer countries in Europe. The UK is ranked in the worst quartile on every nursing resource measure compared with every other country we looked at except one.

“I don’t see any evidence that you have a national staffing policy. You could have that and it seems you could very easily solve this variation in staffing but I don’t see any policy that will make that come to pass.”

On nursing ratios and safe staffing, she urged nurses to use the data and “push back” against policymakers using evidence. She said: “I am not saying that staffing ratios are the ‘be all and end all’ but we have studied them and they do improve staffing, patient outcomes and reduce the nursing shortage and turnover of nursing. They do work.”

Her comments contrast with current nursing workforce policy in the NHS, which has seen work on nurse safe staffing levels by the National Institute for Health and Care Excellence suspended and a move towards a more team based approach by NHS England and chief nurse Jane Cummings.

Professor Aiken said she was “totally opposed to the idea of teams as a policy concept… Teams have no place in policy, and the reason I say that is because as soon as you say team, nurses become invisible. Nurses are the experts on care and there has to be enough of them”.

“We have a paper on skill mix coming out soon which shows nursing is the driving force behind patient outcomes and nursing workforce and as soon as you start trying to substitute anybody else for a nurse, mortality goes up, infections go up, readmission goes up and all of the bad performance measures go up. This is the evidence.”