Transcript Howard Catton Head of Policy The business case for nursing Projections: % Change in NHS nurses 2006/7 to 2015/16, England (wte) 40 2006/7 2015/16 -2 % Buchan/Seccombe best case -4 Buchan/Seccombe.

Howard Catton
Head of Policy
The business case for nursing
Projections: % Change in NHS nurses
2006/7 to 2015/16, England (wte)
6
4
2
0
2006/7
2015/16
-2
%
Buchan/Seccombe best case
-4
Buchan/Seccombe worst case
WRT projection (est.)
-6
-8
-10
-12
-14
(sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008)
RCN Evidence Base for Future Nurse
Reductions in:
• Patient Mortality
• Respiratory, Wound and Urinary Tract Infections
• Number of Falls
• Incidence of Pressure Sores
• Medication Errors
Improvements in:
• Patient Functional Independence
• Patient Experience and Perceptions of Health Care
http://www.rcn.org.uk/support/policy/policy
briefings
Deaths per 1000 patients with complications*
As workloads in hospitals
But as nurse education
increase, so does mortality ... increases, mortality decreases …
95
95
90
90
85
85
80
80
75
75
70
70
65
65
4
6
Staffing (Patients per nurse)
8
20
60
Education (% of nurses with degrees)
*Adjusting for patient and hospital characteristics
L. Aiken, Univ. of Pennsylvania
40
Inpatient Mortality Rates in 118,803 English Surgical Patients
From 30 Trusts in Relation to Nurse Staffing Levels
2.8
2.6
2.4
2.2
2
1.8
1.6
1.4
1.2
1
2.7
2.4
2.2
2
Lowest Pt:Nurse
Ratios
Rafferty, Clarke, Aiken et al., in review
Highest Pt:Nurse
Ratios
Dr Foster Intelligence; Nursing Times, 31 March 09
147 Trusts
Those with a low nurse per bed ratio were twice as
likely as those with a high ratio to have a high HSMR
Mid Staffs, Maidstone & Basildon
Reg v Non Reg and Clinical Staff per Bed ratio
Patient to Nurse Ratios Important in
Nurse Retention
• Higher burnout and greater job dissatisfaction
(precursors of turnover) are strongly related to
patient-to-nurse ratios.
• An increase of 1 patient per nurse increases the
probability of
– high levels of burnout by 23%
– job dissatisfaction by 15%
L. Aiken, Univ. of Pennsylvania
“Services better at Trusts
with the happiest nurses”
Nursing Times, 23 March 2010
• Good HR
• T& D
• Team Working
• Appraisal
- All reduce mortality
West et al; 2002
Onerous Workloads and Chaotic Environments:
Latent Conditions Creating Possibility of Errors
L. Aiken, Univ. of Pennsylvania
State of the Art Metrics for Nursing;
Griffiths, Kings Univ 08
“Front Runners”
• Failure to Rescue
• HCAI
• HCA pneumonia
• Pressure Ulcers
• Falls
Staffing levels, patterns and satisfaction
National Nursing Research Unit,
Kings College 09
• “better clinical and cost outcomes are
achieved by a qualified nursing workforce
comprised primarily of RNs”
• “there is little evidence to suggest a benefit
from replacing unlicensed NAs with LPNs”
Specialist Nurses, Changing Lives
Saving Money. RCN 2010
•
•
•
•
•
Reduce Emergency Admissions
Increase Independence
Health Education and Prevention Advice
Care Planning and Co-ordination
High Patient Satisfaction
“Interventions by specialised nurses were shown to
have a beneficial impact on a range of outcomes for
LTC when compared with usual care.”
“There is no clear evidence of a differential effect on
outcomes between nurses as first contact and
providers of ongoing primary care when compared
with doctors, though patient satisfaction may be
higher with nurse led care.”
EPPI Centre, Institute of Education,
University of London 2009
“Secondary prevention care for heart disease
provided by specialist cardiac nurses and general
practice nurses compared with GPs was found to
improve mortality rates, general health, diet and
levels of exercise and anginal symptoms. Other
comparative benefits include increased patient
follow up rates and reduced hospital
admissions.”
EPPI Centre, Institute of Education,
University of London 2009
Dall et al, Medical Care January 09
•
•
•
•
$1.3 bn per year productivity
Reduction 3.6m hospital days
$6.1bn medical savings
133,000 RNs save 5,900 lives per year
CNO / NHS Institute for I&I
High Impact Changes
• Pressure ulcers occur in 4-10% of patients
admitted to acute hospital in the UK
• Costs range (1-4) £1K - £24K
• Av DGH £1m - £3m
• Total cost for UK £1.4bn - £2.1bn
PATIENT OUTCOMES
REGISTERED NURSES
Key Questions for a Trusts Board
• Patient/Quality Care Impact Assessment
• Actual v Establishment Staffing Levels
• Reg v Non Reg Ratio
• Nurse to Bed and Patient Ratios
• Spend on Training and CPD
Who said …………..
“One has to grow hard
but without ever losing
tenderness”