Aiken L.;Sloane D.;Griffiths P.;Rafferty A.;Bruyneel L.;McHugh M.;Maier C.;Moreno-Casbas T.;Ball J.;Ausserhofer D.;Sermeus W.;Heede K.;Lesaffre E.;Diya L.;Smith H.;Jones S.;Kinnunen J.;Ensio A.;Jylhä V.;Busse R.;Zander B.;Blümel M.;Mantas J.;Zikos D.;Diomidous M.;Scott A.;Matthews A.;Staines A.;Sjetne I.;Holter I.;Brzostek T.;Kózka M.;Brzyski P.;Fuentelsaz-Gallego C.;Gonzalez-María E.;Gomez-Garcia T.;Tishelman C.;Lindqvist R.;Smeds L.;De Geest S.;Schubert M.;Schwendimann R.;Heinen M.;Schoonhoven L.;Van Achterberg T.

2017

January

BMJ Quality and Safety

Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care

Published

()

26

7

559

568

© 2017 BMJ Publishing Group. All Rights Reserved. Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80