Source: New Zealand Nurses Organisation
New research by Auckland University has found addressing nurse shortages in post-operative care may save 182 lives a year because short-staffed wards have higher rates of potentially preventable deaths and complications after their surgeries.
The newly published research analysed 202,428 patients undergoing 223,415 operations against Te Whatu Ora nursing staffing data between 2022 and 2024 with a focus three specific outcomes after 90 days; postoperative mortality (death), complications and “failure to rescue”. Failure to rescue is a medical term for a patient who dies after developing a complication which may be treatable.
Co-author and Auckland University Professor of Surgery Ian Bissett says international academics have been researching “failure to rescue” events for more than a decade. “What’s unique about this research is that it uses New Zealand data linking three years of individual surgical patient outcomes with the nursing staff ratios for each specific shift that the patients were in hospital.”
“The complication rate was 18%, failure to rescue occurred in 15% of these, resulting in a 90-day mortality rate of 2.8%. The study showed that about 45% of the shifts over this period were short staffed to some extent with 28% meeting the predefined criteria for a shift below target,” he says.
“Understaffing of the shifts was directly associated with a higher complication rate, higher failure to rescue rates and deaths. Each one-nurse reduction in nurse staffing per shift was associated with a 7% increase in complications, 7% increase in failure to rescue and a 13% increase in mortality,” Prof Bissett says.
“Modelling projected that correcting observed staffing shortfalls on surgical wards would be associated with 182 fewer post-operative deaths a year. This is estimated to require 166 extra nurses annually.
“This research finds a solution at a service level for a relatively low investment. It shows having enough nurses on the ward so there is no ‘negative variance’ – or staffing below recommended levels – could have a major impact on post-surgical outcomes.”
Prof Bissett says nurse short staffing on the post-surgical wards for the two-year period of the study was 227,570 hours, or a shortfall of 141.3 full-time nurses across the county. “Modelling projected that correcting observed staffing shortfalls on surgical wards would result in 182.2 fewer post-operative deaths a year.”
NZNO Perioperative Nurses College chair Lucy Middleton says the findings reveal the human cost of staffing levels being set to meet arbitrary cost-cutting budgets rather than patient need, and the impact of Te Whatu Ora’s recent recruitment freeze.
“Nurses are at the bedside when patients come out of surgery. We raise the alarm if our patients’ condition is deteriorating. But to do this well, we need to be fully staffed so we can monitor vital signs and immediately escalate any concerns.
“The first few hours and days after surgery are the most important time to closely watch patients. We need to get around to all our patients in a timely way to give them the care and observation they need to ensure they aren’t suffering complications which can escalate quickly after surgery.
“NZNO implores Te Whatu Ora to properly staff our post-operative wards to levels identified through safe staffing tools as this research shows it protects our patients from complications and even death,” Lucy Middleton says.