Study links nurse intention to quit with patient mortality

A new study based on data from Italy has suggested a link between higher patient mortality and nurses wanting to leave their jobs.

Published in the journal Health Policy, the study found a “significant” association between nurses indicating an intent to leave their job and surgery patients dying in hospital.

“We are the first to report that nurses’ intention to leave exposes patients to a greater risk of mortality”


On the other hand, “adequate nurse staffing and work environments” led to better patient outcomes, according to the study, whose authors included internationally renowned nurse workforce academic Linda Aiken.

This report, led by a group of researchers from Italy, Canada, China and the US, was based on data from 1,046 nurses in the surgical wards of 15 public hospitals in Italy in 2015, and responses from staff surveys on intentions to leave.

It looked at the mortality rates of patients aged 50 or older with a hospital stay of at least two days who had undergone surgery.

Researchers’ analysis of the data showed that a 10% increase in nursing staff intending to leave their jobs increased inpatient hospital mortality by 14%.

As well as the correlation with mortality in general, staff intentions to leave had “significant positive effects” on the probability of mortality within 30 days of admission.

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“The results showed that higher intention to leave for nurses and higher nurse-patient workload were associated with higher probability of in-hospital mortality,” the researchers said.

They observed that “high technology hospitals” had lower levels of patient mortality compared to others in the study, but that the impact was “not significant”.

Further, the study found that an increase in nurse-patient workload also increased inpatient hospital mortality.

One patient being added to a nurse’s workload increased mortality chance by 3.4%. The researchers noted that this funding was corroborated by previous studies.

The researchers said that their findings “reveal the consequences of the 2008 financial crisis that determined in Italy, as in many other countries, a slowdown in the hiring of healthcare professionals – especially nurses”.

They further said that a “rigidity” in hiring practices across the Italian health system was potentially causing people to leave the profession, rather than move to a different workplace.

The report read: “The Italian health system is public with a rigid public job market; to work in another hospital, Italian nurses have to pass an open competitive examination, which in addition to being quite difficult, does not occur frequently.

Linda Aiken

“Instead, in the United States, nurses are enrolled through job interviews, meaning that nurses have much more opportunities to change their workplace.”

The study concluded that policymakers should “orient” the healthcare system to reduce the strain on nurses and that more of them should be hired.

They added: “Moreover, through this study we are the first to report that nurses’ intention to leave exposes patients to a greater risk of mortality showing the need to generate retention interventions to contain nurse turnover as, if not managed, it contributes to increase nurse workload.

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“National and local evidence-informed policies aimed at improving nurses’ wages, work environment and wellbeing may represent the essential response of a country’s government to improve job nurse satisfaction, quality of nursing care and the safety of hospitalised patients.”

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