In the European Union (EU), patients can circulate freely to get the best care and nurses can travel for optimum occupational working conditions. Aiken et al. showed that patients in hospitals in which 60% of nurses had a bachelor's degree, who looked after an average of six patients, had a mortality rate almost 30% lower than patients in hospitals where only 30% of nurses had a bachelor's degree and cared for an average of eight patients. Hospitals of seven countries in the EU and two countries of the European Free Trade Association (Norway and Switzerland) were included in the study. It was the first pan-European public report that monitored how many patients were managed by nurses during their last work-shift. This method is considered more accurate than the nurse/population ratio and more informative than other measures, such as the number of full-time equivalent nurses. The nurse/population ration often includes midwives, too. Furthermore, the number of full-time equivalent nurses provides information about how many nurses are in employment, but not how much work in the clinic.
Even in countries with a public health service where patients should receive a standard level of nursing care and nurses should work in similar condition, the findings suggest that important variability within and between countries exists. The skills acquired at university were shown to create the conditions for safe staffing. A 7% reduction in patient mortality for every 10% increase in the number of nurses with bachelor's degrees was reported in this study. Moreover, the continuing presence of graduate nurses in the staff (at least one per shift able to guarantee surveillance and clinical judgment) seemed to create a safer environment for the patients.
The data refer to the time period 2007 - 2010, so the effects of austerity measures introduced in several countries were not investigated. Notably, austerity measures have caused a reduction of the number of nurses at patients' bedside in some countries. Therefore, the remaining nurses have large workload, with negative results on patients. Furthermore, in November 2013, the EU decided to approve two pathways for nursing education (a vocational school or training after 10 years of general education; and a higher education or university pathway after 12 years of education), which is a change from the previous directive that envisioned at least 12 years of general education before nursing education.
Aiken LH, Sloane DM, Bruyneel L, et al, for the RN4CAST consortium. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.