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Ahead of the CNO Summit next month, the Professor of Nursing from the University of Pennsylvania gives a global perspective on the importance of a safe workforce for the future and maximising resources to improve outcomes for patients:
A safe workforce is essential to achieving all the goals we aspire to – accessible healthcare of high quality that is satisfactory to the public and affordable.
Healthcare is labour intensive, and is becoming more so over time. Unlike other sectors of the economy, there are few, if any, technologies that enable the automation of personal healthcare, and indeed most technologies have increased the need for professional nurses (RNs).
Examples of rapidly diffusing technologies that require additional RNs include intensive care, cardiac monitoring, powerful drugs requiring intravenous administration, and electronic health records.
Supportive work environments make it possible for nursing, midwifery and care staff, as well as the wider health and care workforce to achieve the best patient outcomes.
Global research shows that nurse burnout and fatigue are often associated with patient dissatisfaction and expensive adverse patient outcomes, including medical errors, more healthcare-associated infections, and more hospital readmissions.
Pervasive job dissatisfaction results in difficulty attracting and retaining highly qualified clinicians, expensive turnover, high use of supplemental agency staff, and declining interest in health care careers.
The rising costs of healthcare in the context of an aging population challenge us to better determine return on investment in a value context. Value is defined as achieving the best outcomes at the same or lower costs, which aligns to the three gaps identified in the Five Year Forward View, and also directly linked to Leading Change, Adding Value; a framework for nursing, midwifery and care staff.
Human capital investments in professional nurses are often viewed as “soft targets” for cost reductions rather than as having the potential to produce higher quality, patient-centered healthcare at lower costs by preventing expensive complications. Recent research is producing evidence that could change our views about the costs and value of investments in nursing when viewed in the larger context of patient outcomes.
In a recent study of patient satisfaction in NHS hospitals using the NHS National Inpatient Survey, we found variation in nurse staffing between hospitals ranged from 5.6 to 11.5 patients per professional nurse (RN) on day shift. This wide variation in RN staffing is a major explanation for unfavourable care ratings by NHS patients, evidence that refutes the persistent narrative that nurses are uncaring.
We also found in a separate report, substantial differences in nursing skill mix in hospitals, with some hospitals having fewer than half of nursing personnel who were RNs. The lower the proportion of fully qualified nurses, the worse the outcomes, including higher mortality, more infections, falls with injuries, and pressure ulcers. Also, professional nurse outcomes including higher burnout and job dissatisfaction were worse in hospitals with a higher proportion of less than fully qualified professional nurses.
The evidence suggests that adding more less qualified staff does not save any money when the high costs of adverse patient outcomes and the potential for nurse turnover is considered.
Building an evidence base is vital in order to guide policy and support management decisions in the future to achieve better value for investments made in the healthcare workforce. One common theme emerging from international research is that in the acute hospital sector, investments in fully qualified registered nurses have an excellent return on investment, if judged from the perspective of preventing expensive adverse patient outcomes and nurse turnover.
I look forward to seeing you all at the CNO Summit next month and having discussions about safe staffing in England and other countries.
The 2018 CNO Summit will be held at the Liverpool Arena and Conference Centre on March 7 and 8.