Experts said hospitals should see nurses’ intention to leave their jobs as a “warning sign” that improvements are needed.
ADVERTISEMENTWhen nurses have a higher workload and intend to leave their jobs, there could be an increased risk of patient mortality, according to a new study that experts say highlights the importance of improving healthcare environments.
Researchers found a “significant association” between nurses’ intention to leave their jobs and patient mortality in hospitals.
They said the study, which was published in the journal Health Policy, showed the importance of containing turnover which can increase nurses’ workloads as well.
“Nurses want to leave their jobs when care conditions are poor and those same unfavourable care conditions are not good for patients either,” said Linda Aiken, a professor of nursing at the University of Pennsylvania in the US and co-author of the study.
“Nurses’ intention to leave hospitals is a warning sign that all is not well for the remaining nurses or for their patients,” she added in an e-mail.
The study authors analysed data from roughly 37,000 patients aged 50 and older who were admitted to 15 Italian public hospitals in 2015 for at least two days. They used survey data from a nurse workforce study, including more than 1,000 nurses in their dataset.
As part of the workforce study, nurses responded to questions about staffing, workload, job satisfaction, intention to leave the profession, quality of care, and burnout.
“Nurses were surveyed within specific hospitals and patient outcomes data were obtained for patients in those same hospitals,” Aiken explained, adding however that the study authors were not able to “link specific nurses to the care of specific patients within the hospitals studied”.
They found notably that a 10 per cent increase in nurses’ “intention to leave” increased the likelihood of patient mortality by 14 per cent.
When one patient was added to nurses’ workloads, it increased patient mortality by 3.4 per cent, which was a similar finding in other studies.
Health should be a political ‘priority’
It was the first study that showed a link between nurses’ desire to leave their jobs and patient outcomes, experts said.
“This is something new in the scientific literature, [but] on the other hand, is it surprising? No, because we already know that there is a link between nurses' well-being, nurse staffing levels, nurses' education competencies, and the quality of patient care,” said Dominique Vandijck, a professor of health economics, policy and innovation at the University of Ghent in Belgium.
Vandijck, who was not involved in the study, said that one takeaway is that health is not a cost but rather an investment.
“There is no [one size fits all] approach… From a government point of view, we definitely need a vision for the long term. So at least for ten, 15, maybe 20 years, healthcare needs to be a priority for governments, and there needs to be significant investment in healthcare,” he said.
The observational nature of the study means that the researchers could not determine whether nurses’ intention to quit and high workload caused mortality and the study only looked at two Italian regions.
Vandijck said that while there are nuances when generalising results to other countries, he thinks the situation is likely similar in other European countries.
“[Whether] it is in Belgium or Germany, in France or Italy or Spain…if your workload is not balanced in healthcare or other professions, [if people are] not motivated, are a little bit depressed or [at] risk of burnout, it always has an impact on the outcome of your job,” he said.
Aiken said that other hospitals in Italy and elsewhere could use survey data on nurses’ intention to leave their jobs as “an early warning sign that improvements in care environments are warranted”.
ADVERTISEMENTWhile the data for this study dates back to 2015, the results could also “provide insights” into understanding the more recent impact of the COVID-19 pandemic, the authors said.
“Many studies in a variety of countries show that nurse burnout, job dissatisfaction, and intent to leave increased during the pandemic and remain elevated as the pandemic subsides,” Aiken added.
