A heavy nurse workload may place patients’ lives at risk. A study published online Feb. 26 in The Lancet found that assigning an extra patient to nurses increased the risk of inpatient death within 30 days by 7 percent. However, adding better-educated nurses to the mix may decrease this risk.

The RN4CAST study evaluated the nursing workforce at 488 hospitals in 12 European countries to determine how to best meet population health needs. Linda H. Aiken, PhD, of the University of Pennsylvania School of Nursing in Philadelphia, and colleagues evaluated discharge data for 422,730 patients who had surgeries throughout Europe. They surveyed 26,516 nurses participating in RN4CAST to assess nurse staffing and nurse education and determined how nursing variables affected mortality within 30 days of admission.

Increasing nurse workload by one patient increased the likelihood of a hospital patient dying within 30 days by 7 percent. A 10 percent increase in the number of nurses with a bachelor’s degree decreased the likelihood of an inpatient dying within 30 days by 7 percent.

Based on their analysis, the investigators found that mortality would be 30 percent lower in hospitals where 60 percent of nurses have a bachelor’s degree and the average patient load is six compared with hospitals where 30 percent of nurses have a bachelor’s degree and an average patient load of eight.

The researchers noted that their findings were similar to those of studies in the U.S. and Canada and argued that their study can help make the case that investment in qualified nurses is sound. However, they also stressed that more European research is needed “to establish whether our multicountry findings can be replicated for high mortality surgeries and for medical patients; and whether in Europe, like in the USA, nursing is related to a range of adverse outcomes that contribute to high costs.”