• Peter Griffiths said policymakers should proceed with more caution over new nursing roles
  • Researchers behind new study warn increased levels of nursing associates are a safety risk
  • First cohort of nursing associates qualify next month

Policymakers should proceed with more caution over introducing nursing associates, the author of new research on the safety of the roles has told HSJ.

Professor Peter Griffiths, of the University of Southampton, told HSJ that he believed his new work confirmed that other nursing roles were not a safe solution to shortages of registered nurses.

It comes as the first cohort of nursing associates are due to qualify and join the English NHS next month. NHS Improvement has developed safe guidance about it and warned that nurses should not be substituted with associate staff.

However, there is pressure to fill posts, with recent data suggesting the service is short of around 40,000 registered nurses, as demand has increased alongside rapid recruitment since the Mid Staffs public inquiry report in 2013.

The new study published today, funded by the National Institute for Health Research, found that at lower level of registered nurse staffing and a higher use of nursing assistants was associated with a higher death rate. 

Professor Griffiths’ study did not look at nursing associates, which have not yet entered the workforce, but he said the findings had implications for their work.

He said: ”In a time when we know that we are short of registered nurses it is easy to convince ourselves that we can manage without and suffer no negative consequences, or that it might actually be desirable in some circumstances to replace fully qualified registered nurses with others.

“The standard of proof required to establish the link between registered nurse staffing and patient outcomes has been high but the evidence is now high and this study addresses many limitations of what has gone before.”

He warned: “If we applied the same standard of evidence to proposed solutions – adding support staff or new roles such as associate nurses – we would proceed with much more caution. The evidence based solution to registered nurse shortages is registered nurses and that should be the goal.”

The study, Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal observational study, involved the Universities of Southampton, Portsmouth and York and examined three years of hospital data from 32 wards in an English hospital, covering 140,000 patients who were admitted between 1 April 2012 and 31 March 2015.

It says that for every hour less nursing care per patient over the first five days of a hospital stay, the risk of death increased by 3 per cent. High numbers of admissions per nurse also increased the risk of death, whilst adding nursing assistants above current levels increased rather than decreased the risk.

The observational work does not prove causation but is the latest in a string of studies to highlight the importance of registered nurses to safety and the potential risks of substitution.

Professor Griffiths added: “The risk of death went up when nursing assistant staffing was low but it also increased when it went above the typical level for a ward. We are not sure why that happened but we think it is because there are not enough trained nurses to supervise the assistants and assistants don’t have the skills to recognise and act when a patient starts to deteriorate.”