Nurse Staffing and Education and Hospital Mortality

The title accurately describes the study type and method but does not give an accurate understanding of the subject in question. This is acceptable given the highly specific topic of the research. The abstract, on the other hand, is representative of the article, thoroughly describing the reason for conducting the study, its methodology, detailed findings, and interpretation of the results. The introduction exhaustively explores the reasons behind the research.

According to the authors, the financial side of the medical reform noticeably impacts the quality of care. As the cost savings may be achieved quickly via nurse staffing reduction compared to the efficiency improvement process, the majority of the medical establishments across Europe have chosen the nursing personnel as a “soft target.” However, this has led to the introduction of the problem: the adverse effect on the quality of health care.

It is properly outlined in the paper and substantiated by the proper, relevant, and reputable sources. While many of the cited sources already establish a connection between the staffing cuts in nursing personnel and the rise in mortality rates of the patients in Europe, the research of the opposite process is prevalent in North America while almost non-existent in Europe. The purpose of the study explained in the paper is to establish the correlation between the changes in staffing and the respective change in the quality of the nursing service across the facilities of nine European countries.

The research question, “assess whether differences in patient-to-nurse workloads and nurses’ educational qualifications […] are associated with variation in-hospital mortality after common surgical procedures” (Aiken et al., 2014, p. 1825), clearly defines the specific direction of research. As the study is observational, the hypothesis is not stated. The theoretical framework, however, is thoroughly described in the “methods” section. The literature review of the relevant, recent, and reputable sources is included in the introduction and is narrow enough to back the focus on the research question.

The data for the study was collected from administrative sources of each country. No specifics are given in the paper regarding the instruments used during the process. It is confirmed, however, that each grantee has received ethical approval at the institutional and country-level, so it can be safely assumed that no harm was done in the process. The sample (26516 nurses total) is sufficient in size and representative of the target group and thus fits with the research design. The patient data was collected with the consideration of validity and reliability by implementing the procedures by Silber and colleagues (Silber et al., 2000).

Additionally, surgical patients’ data used in the study was chosen as it is better documented and validated. The quantitative analysis was performed by analyzing patient and hospital variables and correlated to the data obtained from nurses’ information, including the Practice Environment Scale of the Nursing Work Index, which served as a control variable (Aiken et al., 2011). The 43 dummy variables were also considered. The paper specifies the absence of bias resulting from the source of funding. There is no mentioning of the tools for either data collection or processing. The results of the analysis are presented in the textual format and are backed by tables.

All of the statistical findings are explained. The results show a clear and conclusive connection between the increase in nurses’ workload and the likelihood of the patients’ death. Besides, the nurses with bachelor’s degrees tend to have lower death rates among their patients. The findings are consistent with the previous research in certain countries (Keogh, 2013; Thomas, Keegan, Barry, & Layte, 2012) and are pertinent to the research question.

Besides, the interpretation offered by the authors highlights the relevance of the findings for the field of nursing. Based on the result, they suggest the danger of inadequate schedules and workload and emphasize the need for properly trained staff. The budget cuts achieved by the understaffing and lowering the educational standards will likely result in negative health outcomes and an overall decrease in quality of the health care. It is worth noting that the research has several limitations. The selection of the patient sample was limited to those undergoing general surgery, which was done to boost reliability but undermined the sample’s diversity.

The data also had a number of unmeasured confounding factors, which could have altered the results. Finally, the alignment between the patients’ and nurses’ data was imperfect. The sources of data allow placing the study at level IIB of evidence (Shekelle, Woolf, Eccles, & Grimshaw, 1999). Nevertheless, the findings are reliable enough to be used as the guidelines for the policymakers and nursing administration segment. By extension, they can also serve as indirect proof of the need for the proper education as a viable investment in case the research will trigger changes in global policies of spending reduction in Europe.


Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12), 1047-1053.

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R.,… & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830.

Keogh, B. (2013). Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. Web.

Shekelle, P. G., Woolf, S. H., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines: developing guidelines. British Medical Journal, 318(7183), 593-596.

Silber, J. H., Kennedy, S. K., Even-Shoshan, O., Chen, W., Koziol, L. F., Showan, A. M., & Longnecker, D. E. (2000). Anesthesiologist direction and patient outcomes. The Journal of the American Society of Anesthesiologists, 93(1), 152-163.

Thomas, S., Keegan, C., Barry, S., & Layte, R. (2012). The Irish health system and the economic crisis. The Lancet, 380(9847), 1056-1057.