HealthDay News — Nurse staffing and education are associated with in-hospital mortality after common surgical procedures, according to a study published online Feb. 26 in The Lancet.

Linda H. Aiken, PhD, from the University of Pennsylvania School of Nursing in Philadelphia, and colleagues conducted an observational study to assess whether nurse staffing and education correlate with in-hospital mortality after common surgical procedures.

Discharge data were reviewed for 422,730 patients who underwent common surgeries. Patients were aged 50 years or older and from 300 hospitals in nine European countries. A total of 26,516 nurses practicing at the study hospitals were surveyed to assess nurse staffing and education.

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The researchers found that the likelihood of an inpatient dying within 30 days of admission increased by 7% with each increase in a nurses’ workload by one patient (odds ratio, 1.068; 95% CI, 1.031 to 1.106) and decreased by 7% for every 10% increase in bachelor’s degree nurses (odds ratio, 0.929; 95% CI, 0.886 to 0.973).

Compared with hospitals in which only 30% of nurses had bachelor’s degrees and nurses care for an average of eight patients, mortality would be almost 30% lower for patients at hospitals in which 60% of nurses had bachelor’s degrees and nurses care for an average of six patients.

“In summary, educational qualifications of nurses and patient-to-nurse staffing ratios seem to have a role in the outcomes of hospital patients in Europe,” the researchers wrote.

In an accompanying editorial, Alvisa Palese, MSN, RN, of the University of Udine in Italy, and Roger Watson, PhD, RN, FAAN, of the University of Hull in the United Kingdom, concluded that the study’s findings highlight and address some important issues.

“The study by Aiken and colleagues provides evidence in favor of appropriate nurse–patient ratios and also provides support for graduate education for nurses. Whether these findings are used to inform health-care policy or how they are implemented in practice willbe interesting to see,” they wrote.”We fear that the evidence here will not be tried and found wanting, but will rather be deemed too expensive to act upon.”


  1. Aiken LH et al. Lancet. 2014; doi:10.1016/S0140-6736(13)62631-8.