Care assistants ‘cannot act as substitutes for Registered Nurses’, warns study

Researchers discovered the risk of patients dying decreased when more registered nurses were on duty.

Matt Bodell
5 December 2018
nurse preparing IV medications

Researchers have found patients are at a higher risk of dying if there are fewer registered nurses are on duty.

A study by the University of Southampton and published in the BMJ has found a three per cent rise in the risk of death for each day there is a shortfall of Registered Nurses.


The study comes as official figures show 40,877 unfilled nursing vacancies in England alone.

Researchers followed nearly 140,000 patients in an acute trust between April 2012 and March 2015 to examine the impact skills mix has on patient outcomes. During the study, the overall morbidity rate was just over 4% reporting 5,662 deaths in total.

Researchers discovered the risk of patients dying increased when there was a shortfall of registered nurses but decreased with more registered nurses on duty. In contrast, the study failed to show any relationship between an increased number of care assistants and a decrease in morbidity rates.

The study says the figures show the potential consequences of a shortfall in registered nurses and the negative impact it can have on patient safety. Adding; “While nursing care assistants also have an important part to play in maintaining the safety of hospital wards, they cannot act as substitutes for Registered Nurses”. 


Going on to warn healthcare providers that registered nurse and nursing assistant hours “should not be treated as equivalent”.

A stark warning.

Dame Donna Kinnair, Royal College of Nursing Acting Chief Executive and General Secretary, said: “As the official count of vacant nurse jobs rises this year, this study shows the death count will too – it’s as stark as that.

“The Government and the NHS in England must pull together to resolve the staffing crisis – patients are paying the highest price for the shortage of nurses.

“This research is the latest in a long line of studies showing that patient safety is at risk from the failure to plan for a long-term workforce.


“Asking nursing students to take on thousands of pounds worth of debt to fund their courses has led to a dramatic fall in the number of students applying for university nursing degrees – so the RCN is calling for at least £1 billion to be invested into nursing higher education.

“This investment needs to go hand in hand with a law that enshrines safe staffing, and ensures we have the right number of nurses, with the right knowledge, in the right place.

“We need accountability at all levels for nurse staffing to keep the public safe.”

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